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: 01-01-14 and 03-31-14 Date of Report: 06-03-14 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 3.000000 $0.0000 $0.0000
SCONLY-SCONLY SERVICE COORDINATION ONLY 82 85 64.877778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 83 86 67.877778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 39 10.736302 $520.7200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 7.339682 $332.3400 $45.2800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 22 22 15.388890 $220.9900 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 28 29 18.683334 $344.9000 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 31 19.305556 $193.4400 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 29 30 18.550000 $156.0100 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 20 20 14.111112 $109.3600 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 29 30 18.394445 $386.2800 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 53 54 40.507146 $2536.9900 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 25 15.738890 $346.5700 $22.0200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.433333 $10.6400 $24.5500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 77 83 109.383335 $6563.0100 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 16 6.146728 $276.6100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 29 31 38.648414 $4444.6000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 6 6 0.805794 $40.2900 $50.0000
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 1 1 1.900000 $57.0000 $30.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.011111 $0.8300 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.011111 $0.8300 $74.9300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.083333 $6.2500 $74.9700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.083333 $4.6200 $55.4800
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 6 6 0.900001 $43.6600 $48.5100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 447 524 170.025402 $8246.2600 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 5 5 1.277778 $61.9700 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 416 493 228.464917 $11080.6000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 531 608 199.799999 $9690.2900 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 12.966667 $1296.6700 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.138889 $6.9500 $50.0000
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Subtotal (Total Children Is Unduplicated) 1323 2064 949.835502 $46978.6800 $49.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 10 5.085692 $25428.0000 $4999.9100
AUD -HA_FUP AUDIOLOGY SERVICES 24 27 49.153969 $2457.7000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 0.349505 $17.4800 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1606 1794 6348.365863 $317418.2400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 4 4 1.766666 $44.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1598 1797 6371.342844 $318567.0700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.266666 $31.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1602 1789 6289.266654 $314463.2700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2266 2586 7032.402369 $351620.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.066667 $51.6700 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 5 5 437.857142 $5473.2100 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 221 261 2079.652396 $51991.2300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3460 4196 33712.712033 $1685633.9600 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 24 27 172.758333 $8637.9200 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 15 15 96.847620 $4842.3900 $50.0000
INTR -INTR INTERPRETER 5 5 31.044444 $1552.2200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1013 1210 8204.677382 $556933.2300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 14 14 100.095238 $5437.1700 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1287 1492 9641.476188 $654463.0300 $67.8800
PHY -97110HM PT SESSION BY PT ASST 18 18 101.430159 $5509.6800 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 3 4 1.066667 $533.3500 $500.0200
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 9 2.480061 $161.2100 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 10 5.349011 $1219.5900 $228.0000
SENS -V5264 EARMOLD 36 39 24.444445 $440.0000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 4.300000 $215.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 66 83 130.218255 $6510.9200 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1581 1823 11994.213106 $814166.7200 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 29.857143 $1621.8400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 18 19 99.185715 $1309.2500 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 3 3 24.171429 $2417.1400 $100.0000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 2663 4436 34641.163586 $346411.4500 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1079 3416 1193860.960323 $596930.4800 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 18 18 66.791667 $3339.5900 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 17 20 89.024604 $4451.2300 $50.0000
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Subtotal (Total Children Is Unduplicated) 5556 25145 1321654.277175 $6090425.9600 $4.6100
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Total 27295 1322671.990455 $6137404.6400 $4.6400
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Number of Children (Unduplicated) With at Least One Authorization 5645