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: 04-01-14 and 06-30-14 Date of Report: 08-18-14 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 24 24 20.144442 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 24 24 20.144442 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 2.838890 $137.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.266667 $12.0800 $45.2900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.222222 $3.1900 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.222222 $4.1000 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.222222 $2.2300 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.222222 $1.8700 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.222222 $1.7200 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.222222 $4.6700 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 8 8 2.322223 $145.4500 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.222222 $4.8900 $22.0200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.505556 $12.4100 $24.5500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 5 5 0.972221 $58.3300 $59.9900
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.461111 $168.0300 $115.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 31 31 9.038892 $438.4000 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 1.011112 $49.0400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 27 27 8.344449 $404.7300 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 78 78 25.166682 $1220.6600 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 10.142857 $1014.2900 $100.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 134 172 63.626214 $3683.7700 $57.9000
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 19.074603 $953.7300 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 184 185 290.222235 $14511.1800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 181 181 350.041265 $17502.0500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 192 192 321.775400 $16088.7900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 542 543 618.142862 $30907.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 0.644444 $16.1100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.800000 $20.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 454 461 3282.336503 $164116.8800 $50.0000
INTR -INTR INTERPRETER 1 1 9.600000 $480.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 69 362.647618 $24616.5300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 12.133333 $659.0800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 85 86 513.630154 $34865.2000 $67.8800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.727778 $47.3100 $65.0000
SENS -V5264 EARMOLD 2 2 0.816666 $14.7000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 9 9 16.044444 $802.2200 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 180 182 1083.326189 $73536.2400 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.428571 $457.8400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 26.000000 $343.2000 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 14.400000 $1440.0000 $100.0000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1449 2055 13505.622220 $135056.2100 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 154 344 82205.550788 $41102.7800 $0.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1897 4324 102641.965073 $557537.2200 $5.4300
-------------------------------------------------------------------------------------------------------------------------------------
Total 4520 102725.735729 $561220.9900 $5.4600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1936