Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 5 5 6.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 5 5 6.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 4.10 $489.87 $119.60
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 3.00 $166.50 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 34 34 71.21 $5341.07 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 34 35 64.50 $4837.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 18 18 34.00 $2550.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 78 78 151.71 $8420.14 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.00 $450.00 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 115 141 153.57 $7448.21 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 112 114 114.00 $5529.00 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 154 190 203.14 $9852.43 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 99 102 102.00 $4947.00 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 469 569 574.57 $27866.71 $48.50
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Subtotal (Total Children Is Unduplicated) 657 1291 1482.81 $77973.44 $52.58
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 0.07 $3.29 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 140 156 197.29 $9864.29 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 13 13 14.00 $350.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 272 322 718.21 $35910.41 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 99 119 256.93 $12846.66 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 92 110 247.97 $12398.70 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 282 328 682.45 $34122.40 $50.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.07 $225.16 $73.42
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 423 525 4214.40 $210720.23 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 1.79 $89.29 $50.00
INTR -INTR INTERPRETER 9 12 79.93 $3996.43 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 204 252 2010.77 $136490.87 $67.88
PHY -97110 PT SESSION BY LICENSED PT 231 294 2395.17 $162584.35 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 7 7 5.78 $5.78 $1.00
SENS -FM FM RECEIVER HEARING AID 1 1 1.00 $1650.00 $1650.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 2 22.00 $5216.64 $237.12
SENS -V5264 EARMOLD 4 4 7.00 $131.04 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 469 583 4415.59 $299729.98 $67.88
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 7 7 49.05 $2452.31 $50.00
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Subtotal (Total Children Is Unduplicated) 844 2740 15324.45 $931787.78 $60.80
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Total 4036 16813.26 $1009761.22 $60.06
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Number of Children (Unduplicated) With at Least One Authorization 865