Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Statewide
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 10-01-13 and 12-31-13 Date of Report: 02-18-14 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1 0.400000 $0.0000 $0.0000
SCONLY-SCONLY SERVICE COORDINATION ONLY 127 136 109.065864 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 128 137 109.465864 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 50 55 18.168719 $881.1700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.253968 $56.7800 $45.2800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 12 12 4.888890 $70.2100 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 12 12 4.544445 $83.8900 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 14 6.422223 $64.3500 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 15 15 7.400001 $62.2300 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 10 10 3.166667 $24.5400 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 14 7.300001 $153.3000 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 28 28 10.033334 $628.3900 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 12 12 4.455556 $98.1100 $22.0200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.433333 $10.6400 $24.5500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 80 84 261.731206 $15703.9000 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 15 12.789715 $575.5400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 27 30 39.057139 $4491.5300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 19 19 3.994826 $199.7400 $50.0000
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 1 1 3.066667 $92.0000 $30.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 9 9 3.737301 $181.2600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 371 448 169.972998 $8243.6100 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 7 7 2.194444 $106.4300 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 328 398 192.138515 $9318.7200 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 314 350 139.484933 $6765.0300 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.142857 $14.2900 $100.0300
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 1050 1538 896.888849 $47851.2200 $53.3500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 21 30.083333 $150416.5000 $4999.9900
AUD -HA_FUP AUDIOLOGY SERVICES 16 20 60.772225 $3038.6200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 94 117 90.347851 $4517.4100 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 1.444444 $36.1100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1472 2649 4009.880170 $200494.2200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 20 20 32.433337 $810.8400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1316 2496 3751.675822 $187584.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 6.355555 $158.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1373 2562 3780.656379 $189032.9600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 12 12 22.266670 $556.6800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2019 3332 4639.286544 $231964.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 11 11.988890 $299.7300 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 10 10 1781.142859 $22264.2900 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 202 258 2224.580934 $55614.6300 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 1.466667 $73.3400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 1.466667 $73.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3445 4587 34410.226800 $1720513.2800 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 23 26 181.333333 $9066.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 29 30 179.663492 $8983.2000 $50.0000
INTR -INTR INTERPRETER 20 21 248.287302 $12414.3700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 925 1197 8037.849958 $545609.6800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 15 15 118.464286 $6434.9800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1159 1500 9154.146796 $621383.8700 $67.8800
PHY -97110HM PT SESSION BY PT ASST 26 26 220.363494 $11970.1600 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 1.477778 $738.9000 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 7 3.154110 $205.0200 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 10 4.847109 $1105.1400 $228.0000
SENS -V5264 EARMOLD 31 36 39.228571 $706.1100 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 0.300000 $15.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 57 75 178.653968 $8932.7000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1232 1545 9785.618636 $664248.2900 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 24.785715 $1346.3600 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 18 19 101.966668 $1345.9600 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 7.866667 $786.6700 $100.0000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 2415 4257 32340.958568 $323409.7800 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1088 2519 502475.799047 $251237.9000 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 23 26 152.341469 $7617.0800 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 21 22 128.071429 $6403.5800 $50.0000
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Subtotal (Total Children Is Unduplicated) 5152 27443 618241.253543 $5251410.6800 $8.4900
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Total 29118 619247.608256 $5299261.9000 $8.5600
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Number of Children (Unduplicated) With at Least One Authorization 5273