Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 34 40 53.14 $2577.43 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
EVAL -EVAL DEVELOPMENTAL EVALUATION 242 276 295.71 $14785.40 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 2 2 2.00 $100.00 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 307 369 389.34 $18882.90 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 229 285 302.21 $14657.17 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 378 450 530.23 $25716.10 $48.50
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 14.14 $707.15 $50.00
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Subtotal (Total Children Is Unduplicated) 817 1425 1587.77 $77462.21 $48.79
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 30 30 32.07 $1603.34 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 481 623 1252.34 $62617.04 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 207 269 508.60 $25430.10 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 122 161 295.78 $14789.10 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 308 370 669.79 $33489.58 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.43 $35.83 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 15 15 20.73 $1522.13 $73.42
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 210 300 1138.85 $28471.28 $25.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 2 2 15.43 $771.43 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 5.14 $128.57 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 897 1275 9260.07 $463003.63 $50.00
INTR -INTR INTERPRETER 1 1 0.50 $25.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 399 544 2597.25 $176301.25 $67.88
OCCT -97530HM OT SESSION BY OT ASST 1 2 13.14 $713.92 $54.32
PHY -97110 PT SESSION BY LICENSED PT 375 534 2695.88 $182996.64 $67.88
PHY -97110HM PT SESSION BY PT ASST 2 2 26.29 $1427.84 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 25 29 24.01 $24.01 $1.00
SENS -V5264 EARMOLD 1 1 1.00 $18.72 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 22 31 81.60 $4080.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 513 662 3154.80 $214147.51 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.57 $73.54 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 2 2 10.35 $1035.24 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 764 1114 3937.36 $1968.68 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 17 25 99.63 $4981.68 $50.00
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Subtotal (Total Children Is Unduplicated) 1277 5996 25847.63 $1219656.04 $47.19
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Total 7421 27435.40 $1297118.25 $47.28
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Number of Children (Unduplicated) With at Least One Authorization 1324