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
SCONLY-SCONLY SERVICE COORDINATION ONLY 82 85 64.877778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 82 85 64.877778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 26 29 8.547412 $414.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.911111 $41.2500 $45.2800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 3.488890 $50.1000 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 5 3.488890 $64.4100 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 5 3.488890 $34.9600 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 5 3.488890 $29.3400 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 5 3.488890 $27.0400 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 3.488890 $73.2700 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 23 23 9.783337 $612.7500 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 6 6 3.644446 $80.2500 $22.0200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.433333 $10.6400 $24.5500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 22 23 40.000002 $2400.0100 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.233334 $10.5000 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 9.646826 $1109.3900 $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 2 2 0.338889 $16.4400 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 74 81 27.488892 $1333.2300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.838889 $40.6900 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 60 65 24.573016 $1191.8000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 170 196 66.883331 $3243.8300 $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) 318 482 230.256396 $12197.8900 $52.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.007915 $5039.5000 $4999.9300
AUD -HA_FUP AUDIOLOGY SERVICES 9 9 28.042064 $1402.1100 $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 442 464 894.377785 $44718.9300 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 4 4 1.766666 $44.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 414 454 846.384126 $42319.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.266666 $31.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 439 471 874.280951 $43714.0400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1106 1261 1611.286506 $80564.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.066667 $51.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 17.723810 $443.1000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 907 1052 9278.181770 $463908.6600 $50.0000
INTR -INTR INTERPRETER 5 5 31.044444 $1552.2200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 148 170 1194.960316 $81113.8600 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 10.666667 $579.4200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 168 187 1208.530161 $82034.9800 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 3 3 0.672223 $336.1500 $500.0600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 1.163394 $75.6200 $65.0000
SENS -V5264 EARMOLD 10 10 4.383335 $78.9000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 17 22 18.892065 $944.6000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 362 422 2866.265874 $194562.0800 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 22.714286 $1233.8400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 5 6 39.828572 $525.7400 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 3 3 24.171429 $2417.1400 $100.0000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 2662 4429 34589.942953 $345899.2500 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 455 953 233996.620639 $116998.3100 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 5.100000 $255.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3684 9950 287572.124122 $1510872.7700 $5.2500
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Total 10517 287867.258296 $1523070.6700 $5.2900
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Number of Children (Unduplicated) With at Least One Authorization 3799