Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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
TCM -T1017TL TARGETED CASE MANAGEMENT 13 13 9.21 $340.84 $37.00
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Subtotal (Total Children Is Unduplicated) 13 13 9.21 $340.84 $37.00
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 2.00 $97.00 $48.50
AUDE -AUDE UNSPECIFIED AUDE SERVICES 8 11 34.57 $2074.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 13 13.58 $635.44 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 13 14.06 $1681.23 $119.60
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.00 $125.00 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 12 13 16.00 $800.00 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 7 7 7.00 $339.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 4 5 5.00 $242.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 7 7 7.00 $339.50 $48.50
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Subtotal (Total Children Is Unduplicated) 53 72 100.20 $6334.17 $63.21
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 15 17.00 $25500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 30 38 65.71 $3285.63 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 46 58 87.86 $4392.86 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 3 3.00 $75.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 60 66 96.03 $4801.43 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 8 10 11.28 $282.08 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 101 117 145.97 $7298.45 $50.00
CONOP -CONOP CONSULT, OT, PHONE 16 17 18.37 $459.26 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 69 73 92.12 $4605.88 $50.00
CONPP -CONPP CONSULT, PT, PHONE 9 10 8.78 $219.38 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 104 111 162.23 $8111.31 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 13 14 19.29 $482.26 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 86 95 1191.43 $29785.74 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 488 631 5180.04 $259001.91 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 3.07 $153.34 $50.00
INTR -INTR INTERPRETER 25 26 194.71 $9735.72 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 401 530 2724.01 $184905.62 $67.88
OCCT -97530HM OT SESSION BY OT ASST 13 21 125.30 $6806.30 $54.32
PHY -97110 PT SESSION BY LICENSED PT 459 616 3569.02 $242265.17 $67.88
PHY -97110HM PT SESSION BY PT ASST 4 4 20.25 $1099.98 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 9 10 14.41 $14.41 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 8 8 8.00 $4000.00 $500.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 1.00 $237.12 $237.12
SENS -V5264 EARMOLD 10 10 7.27 $136.03 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 971 1290 8714.43 $591535.38 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 32.86 $1784.80 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 15 16 112.14 $1480.29 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 8 11 13.00 $1300.00 $100.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 21 26 254.64 $12731.92 $50.00
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Subtotal (Total Children Is Unduplicated) 1387 3833 22893.20 $1406487.23 $61.44
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Total 3918 23002.62 $1413162.24 $61.43
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Number of Children (Unduplicated) With at Least One Authorization 1397