Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 43 46 18.27 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 19 23 15.00 $555.00 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 1.51 $55.91 $37.00
TCON -TCON TRANSITION CONFERENCE 1 1 1.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 56 72 35.78 $610.91 $17.07
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.02 $0.93 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 12.71 $458.60 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 42 42 40.22 $2413.00 $60.00
AUDE -V5090 DISPENSING FEE PER HEARING AID 19 20 20.51 $2453.13 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 2.00 $250.00 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 4 15.00 $1875.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 23 23 54.36 $6795.54 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 20 20 20.00 $600.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.06 $4.58 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.27 $20.42 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.50 $138.75 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 11.50 $862.50 $75.00
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 2 2.00 $97.00 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 86 96 137.20 $6654.36 $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 114 124 122.27 $5930.30 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 14 14 14.00 $700.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 360 413 452.24 $21933.66 $48.50
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Subtotal (Total Children Is Unduplicated) 545 786 909.88 $51436.27 $56.53
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 16 16 16.00 $800.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 543 626 1279.32 $63966.05 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 107 114 222.81 $5570.15 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 14 51.30 $2564.78 $50.00
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.53 $113.34 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 17 30.03 $1501.67 $50.00
CONPP -CONPP CONSULT, PT, PHONE 3 4 7.13 $178.34 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 599 699 1359.24 $67961.87 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 73 81 137.33 $3433.34 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 20 21 77.99 $5725.75 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 2 2 293.00 $3662.50 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 19 20 185.29 $4632.14 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 10.71 $535.72 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 27.14 $1357.15 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 3 3 22.43 $560.72 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 793 974 7925.01 $396250.57 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 71 78 431.86 $29314.45 $67.88
OCCT -97530HM OT SESSION BY OT ASST 64 69 367.92 $19985.60 $54.32
PHY -97110 PT SESSION BY LICENSED PT 133 147 827.30 $56157.44 $67.88
PHY -97110HM PT SESSION BY PT ASST 80 83 536.43 $29138.83 $54.32
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.00 $1000.00 $500.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 16 21 183.80 $9190.24 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 191 213 931.87 $63255.43 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 38.43 $2087.45 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 123 136 706.81 $9329.85 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 3 3 36.86 $3685.72 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 836 1378 9774.88 $4887.43 $0.50
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Subtotal (Total Children Is Unduplicated) 1050 4731 25487.43 $786846.47 $30.87
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Total 5589 26433.09 $838893.65 $31.74
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Number of Children (Unduplicated) With at Least One Authorization 1078