Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 07/01/08 and 09/30/08 Date of Report: 11-18-08 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 1.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 1 1 1.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 3 3 3.00 $180.00 $60.00
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.00 $119.60 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 24 25 25.00 $1250.00 $50.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.00 $111.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 81 81 135.29 $10146.43 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 39 40 59.00 $4425.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 21 21 27.53 $2065.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 98 103 162.29 $9006.86 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 13.50 $1012.50 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 16 16 16.00 $776.00 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 8 8 8.00 $388.00 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 2 2 2.00 $100.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 20 21 21.00 $1018.50 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 3.00 $300.00 $100.00
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Subtotal (Total Children Is Unduplicated) 172 337 481.60 $31045.88 $64.46
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 12 16.00 $24000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 6 6 5.23 $261.67 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 4 4.36 $217.86 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 3.30 $82.50 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 9 12 24.19 $1209.65 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 11 11 21.19 $529.64 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 18 18 39.78 $1988.82 $50.00
CONOP -CONOP CONSULT, OT, PHONE 10 10 12.52 $312.92 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.92 $45.84 $50.00
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.00 $50.00 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 27 29 50.43 $2521.32 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 17 17 19.23 $480.83 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 11 12 2510.86 $31385.71 $12.50
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 136 155 1226.60 $61329.81 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 13.71 $685.72 $50.00
INTR -INTR INTERPRETER 4 5 8.00 $400.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 70 89 620.03 $42087.58 $67.88
OCCT -97530HM OT SESSION BY OT ASST 28 33 213.70 $11607.99 $54.32
PHY -97110 PT SESSION BY LICENSED PT 44 56 456.83 $31009.29 $67.88
PHY -97110HM PT SESSION BY PT ASST 21 27 132.31 $7187.32 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 6 6 6.00 $6.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 1.00 $500.00 $500.00
SENS -V5264 EARMOLD 1 1 1.00 $18.72 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 123 154 1360.29 $92336.56 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 12.29 $667.36 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 42 47 375.71 $4959.43 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 2 2 15.00 $1500.00 $100.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 6 34.40 $1719.77 $50.00
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Subtotal (Total Children Is Unduplicated) 337 722 7186.86 $319102.28 $44.40
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Total 1060 7669.46 $350148.16 $45.65
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Number of Children (Unduplicated) With at Least One Authorization 372