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
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 147 157 135.254753 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 148 158 135.654753 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 66 73 23.104563 $1120.5600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.253968 $56.7800 $45.2800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 22 22 6.688890 $96.0500 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 28 32 9.427778 $174.0400 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 34 11.305556 $113.2800 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 30 34 12.027778 $101.1500 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 19 19 4.711111 $36.5100 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 34 12.183334 $255.8500 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 60 60 21.606349 $1353.2100 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 26 8.144444 $179.3400 $22.0200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.433333 $10.6400 $24.5500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 122 130 426.830600 $25609.8700 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 17 22 16.178603 $728.0300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 40 43 59.796211 $6876.5100 $115.0000
EXIT -EXIT EXIT ASSESSMENT 25 25 4.624963 $231.2500 $50.0000
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 1 1 3.066667 $92.0000 $30.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.511111 $38.3300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.511111 $28.3700 $55.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 13 13 4.809524 $233.2700 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 581 702 279.915851 $13575.8300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 11 11 3.549999 $172.1700 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 482 591 287.182654 $13928.3600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 665 767 322.680158 $15649.9300 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 1.342857 $134.2900 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 1701 2647 1522.398524 $80821.1700 $53.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 34 38 43.084551 $215423.0000 $5000.0100
AUD -HA_FUP AUDIOLOGY SERVICES 34 44 101.570821 $5078.5400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 139 171 123.026311 $6151.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 1.444444 $36.1100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2238 4081 6191.399271 $309570.4400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 24 24 41.333338 $1033.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2058 3908 5936.374284 $296819.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 12.488889 $312.2200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2050 3892 5880.851663 $294042.9500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 14 25.033337 $625.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3077 5143 7187.945311 $359397.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 13 14.755557 $368.8900 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 10 10 1781.142859 $22264.2900 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 252 321 2863.614263 $71590.4800 $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 4586 6108 45782.168019 $2289110.6700 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 32 36 248.616666 $12430.8300 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 35 36 203.886507 $10194.3500 $50.0000
INTR -INTR INTERPRETER 21 22 252.376191 $12618.8100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1403 1812 12258.517404 $832108.8200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 22 22 164.223810 $8920.6400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1692 2191 13575.188836 $921484.3600 $67.8800
PHY -97110HM PT SESSION BY PT ASST 31 31 260.934922 $14174.0000 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 6 6 2.832724 $1416.3000 $499.9800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 9 4.442999 $288.8000 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 0.255556 $29.1400 $114.0200
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 14 16 8.791553 $2004.4600 $228.0000
SENS -V5264 EARMOLD 56 69 62.633515 $1127.4000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 2 2 5.300000 $265.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 80 104 230.674602 $11533.7300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2281 2930 19105.877340 $1296907.7700 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 6 46.500001 $2525.8800 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 26 28 150.827778 $1990.9300 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 7.866667 $786.6700 $100.0000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 3222 5775 43475.007723 $434750.2700 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1612 3727 758891.931594 $379445.9600 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 27 33 172.408136 $8620.4200 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 27 29 162.931746 $8146.6000 $50.0000
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Subtotal (Total Children Is Unduplicated) 7416 40665 925281.192522 $7833742.6600 $8.4700
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Total 43470 926939.245799 $7914563.8300 $8.5400
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Number of Children (Unduplicated) With at Least One Authorization 7562