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
SCONLY-SCONLY SERVICE COORDINATION ONLY 147 157 135.254753 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 147 157 135.254753 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 56 62 19.265219 $934.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.111111 $5.0300 $45.2800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 1.033333 $14.8400 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 1.033333 $19.0700 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 1.033333 $10.3500 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 1.033333 $8.6900 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 4 4 1.033333 $8.0100 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 1.033333 $21.7000 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 23 23 7.672222 $480.5100 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 2.055555 $45.2600 $22.0200
AUDE -AUDE UNSPECIFIED AUDE SERVICES 30 31 174.922224 $10495.3400 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.888889 $85.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 8 8.666665 $996.6500 $115.0000
EXIT -EXIT EXIT ASSESSMENT 23 23 4.427703 $221.3900 $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 1 1 0.511111 $24.7900 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 106 115 48.285714 $2341.8600 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.211111 $10.2400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 66 78 38.870634 $1885.2200 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 207 235 122.841266 $5957.7800 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.200000 $120.0000 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 425 615 441.729422 $23870.3500 $54.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 13 3.495663 $17479.0000 $5000.2000
AUD -HA_FUP AUDIOLOGY SERVICES 17 21 80.604765 $4030.2400 $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 2146 2697 3920.622832 $196030.4000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 24 24 41.333338 $1033.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1965 2510 3624.348626 $181216.6000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 12.488889 $312.2200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1956 2520 3618.692679 $180933.7600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 14 25.033337 $625.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2986 3759 4907.867285 $245392.4400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 13 14.755557 $368.8900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 12 180.257143 $4506.4300 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 1.466667 $73.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1290 1693 12507.822955 $625391.5200 $50.0000
INTR -INTR INTERPRETER 21 22 252.376191 $12618.8100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 235 284 1755.665871 $119174.6600 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 3 3 16.928571 $919.5600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 256 314 1802.992848 $122387.1900 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 3 3 2.500000 $1250.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 8 3.420777 $222.3600 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 1.233334 $281.2200 $228.0100
SENS -V5264 EARMOLD 14 16 13.277778 $239.0000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 22 26 35.780951 $1789.0400 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 541 678 4449.681731 $302044.5200 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 21.714286 $1179.5200 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 47.484920 $626.8000 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 7.866667 $786.6700 $100.0000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 3221 5770 43445.579152 $434455.9800 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1164 2086 542621.112545 $271310.5500 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 9.200000 $460.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 6136 22681 623550.076113 $2733327.3700 $4.3800
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Total 23453 624127.060288 $2757197.7200 $4.4200
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Number of Children (Unduplicated) With at Least One Authorization 6320