Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10/01/08 and 12/31/08 Date of Report: 02-16-09 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 13.14 $486.29 $37.00
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Subtotal (Total Children Is Unduplicated) 1 1 13.14 $486.29 $37.00
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 22 24 25.00 $1212.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 4.00 $144.28 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.00 $10.62 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.00 $17.66 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.00 $10.80 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.00 $21.79 $21.79
AUDE -AUDE UNSPECIFIED AUDE SERVICES 27 27 26.26 $1575.33 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 5.00 $234.00 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 10 16.00 $1913.60 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 5 6 10.00 $500.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 46 49 77.54 $3876.79 $50.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.50 $112.50 $75.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 27 27 39.00 $2925.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.50 $112.50 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 3.50 $262.50 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 9 13.50 $1012.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 21 21 32.50 $1803.75 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 287 289 391.79 $29383.94 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 32 32 38.50 $2887.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 72 73 119.64 $8973.22 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 257 257 361.50 $20063.26 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 241 255 353.36 $26501.79 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 2 14.14 $685.93 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 25 25 34.14 $1655.93 $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 19 19 28.14 $1364.93 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 23 23 47.00 $2279.50 $48.50
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Subtotal (Total Children Is Unduplicated) 633 1167 1650.51 $109617.71 $66.41
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 45 60 66.00 $99000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 29 30 106.21 $5310.49 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 61 77.06 $3852.98 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 21 24 20.60 $515.06 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 19 20 35.46 $1773.10 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 32 37 112.37 $2809.34 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 3.50 $174.77 $50.00
CONOP -CONOP CONSULT, OT, PHONE 7 8 27.04 $675.95 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 11 15.50 $775.00 $50.00
CONPP -CONPP CONSULT, PT, PHONE 20 23 71.34 $1783.45 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 34 34 55.70 $2784.87 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 72 80 129.83 $3245.75 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 52.57 $1314.29 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 66 81 720.14 $18003.59 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 13 162.43 $8121.44 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 607 722 5184.50 $259224.83 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 0.14 $7.15 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 18.57 $928.58 $50.00
INTR -INTR INTERPRETER 41 44 315.33 $15766.57 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 197 253 2018.07 $136986.83 $67.88
OCCT -97530HM OT SESSION BY OT ASST 21 21 200.36 $10883.41 $54.32
PHY -97110 PT SESSION BY LICENSED PT 325 424 3432.81 $233019.18 $67.88
PHY -97110HM PT SESSION BY PT ASST 24 24 195.25 $10606.13 $54.32
RSPT -RSPT RESPITE 1 1 49.07 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 70 71 371.81 $371.81 $1.00
SENS -FM FM RECEIVER HEARING AID 5 5 6.00 $9900.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 8.00 $4000.00 $500.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 4.00 $948.48 $237.12
SENS -V5264 EARMOLD 16 16 28.07 $525.43 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 2 7.57 $378.57 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 5 5 18.34 $917.15 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 984 1269 10304.19 $699448.70 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 14.14 $768.24 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 73 73 662.79 $8748.77 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 3 3 24.29 $2428.57 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1244 2101 15210.41 $7605.18 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 31.57 $1578.58 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 11 13 74.71 $3735.72 $50.00
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Subtotal (Total Children Is Unduplicated) 1555 5545 39835.75 $1558917.91 $39.13
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Total 6713 41499.40 $1669021.91 $40.22
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Number of Children (Unduplicated) With at Least One Authorization 1682