Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 519 519 624.29 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 519 519 624.29 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 3.00 $145.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.02 $36.87 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 3 3 1.63 $98.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 6.74 $315.64 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 14 16.00 $1913.60 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 6 6 6.00 $300.00 $50.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 9 9.00 $499.50 $55.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 27 27 27.00 $1309.50 $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 5 5 5.00 $242.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 8 10 13.14 $637.43 $48.50
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Subtotal (Total Children Is Unduplicated) 73 87 90.54 $5622.04 $62.09
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 11 12.00 $18000.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.02 $70.39 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.02 $70.39 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 26 28 91.42 $4571.03 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 44 46 62.98 $3148.82 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 49 51 58.25 $2912.39 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.00 $25.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 37 45.00 $2250.00 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 77 89 127.82 $6391.19 $50.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 36 38 128.36 $9423.99 $73.42
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 2.71 $67.86 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 5 16.29 $814.29 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 6 6 29.21 $1460.48 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 21 21 130.43 $6521.44 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 482 665 4710.18 $235508.85 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 13.14 $657.15 $50.00
INTR -INTR INTERPRETER 3 5 7.43 $371.43 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 618 937 5649.69 $383501.15 $67.88
OCCT -97530HM OT SESSION BY OT ASST 9 11 41.59 $2258.94 $54.32
PHY -97110 PT SESSION BY LICENSED PT 564 808 5312.21 $360593.15 $67.88
PHY -97110HM PT SESSION BY PT ASST 5 5 27.93 $1517.08 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 3 3 3.00 $3.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 12 14 15.00 $7500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 16 17 5.31 $228.20 $43.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 4 4 5.00 $1185.60 $237.12
SENS -V5264 EARMOLD 26 28 35.91 $672.17 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 3 3 3.93 $196.43 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1153 1733 11321.68 $768515.34 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.00 $54.32 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 16.00 $211.20 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 1 1.00 $50.00 $50.00
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Subtotal (Total Children Is Unduplicated) 1610 4576 27877.50 $1818751.26 $65.24
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Total 5182 28592.33 $1824373.29 $63.81
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Number of Children (Unduplicated) With at Least One Authorization 1628