Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 105 108 108.00 $1146.96 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 102 105 105.00 $927.15 $8.83
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 104 107 107.00 $1155.60 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 101 104 104.00 $2266.16 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 96 98 98.00 $2771.44 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 89 109 109.00 $6540.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 16 21 21.00 $982.80 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 15 20.00 $2392.00 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 30 34 22.12 $1105.83 $50.00
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Subtotal (Total Children Is Unduplicated) 213 701 694.12 $19287.94 $27.79
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 36 44 175.00 $262500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 21 29 78.17 $3908.33 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 94 107 129.75 $6487.50 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3 3 3.53 $176.67 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 116 159 177.11 $8855.26 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 14 15.81 $790.28 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 156 211 223.93 $11196.45 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.38 $84.44 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 34 45 307.93 $7698.33 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 1 1 1.02 $51.11 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 2 2 31.33 $783.33 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 298 487 3905.32 $195266.13 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 25 27 97.73 $4886.66 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 413 595 2369.32 $160829.24 $67.88
OCCT -97530HM OT SESSION BY OT ASST 2 2 1.37 $74.23 $54.32
PHY -97110 PT SESSION BY LICENSED PT 540 792 2794.53 $189692.91 $67.88
PHY -97110HM PT SESSION BY PT ASST 7 7 31.48 $1710.18 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 74 74 73.89 $73.89 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 5 6 11.00 $5500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 7.00 $301.00 $43.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 5 5 8.00 $1896.96 $237.12
SENS -V5264 EARMOLD 15 18 33.67 $630.24 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 25 38 127.13 $6356.68 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 786 1141 4739.16 $321694.33 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 24.60 $324.72 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 23 54 172.41 $8620.56 $50.00
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Subtotal (Total Children Is Unduplicated) 1297 3879 15545.57 $1200617.41 $77.23
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Total 4580 16239.69 $1219905.35 $75.12
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Number of Children (Unduplicated) With at Least One Authorization 1324