Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01/01/08 and 12/31/08 Date of Report: 02-16-09 Page: 1
Child has a MEDICAID # Filter: Y
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 3 3 3.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 3 3 3.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 1.00 $54.38 $54.38
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 1.00 $60.00 $60.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 10 10 10.00 $500.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 22 23 29.00 $1450.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 1.50 $112.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 1.50 $83.25 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 134 135 237.36 $17801.78 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 88 91 127.50 $9562.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 69 69 90.03 $6752.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 206 213 314.35 $17446.55 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 36 38 49.00 $3675.00 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 6.29 $304.86 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 17 19 19.00 $921.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 12 12 12.00 $582.00 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 23 25 25.00 $1212.50 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 2.00 $200.00 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.00 $100.00 $50.00
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Subtotal (Total Children Is Unduplicated) 304 647 929.53 $60855.39 $65.47
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 13.00 $19500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 5 5 8.33 $416.67 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 8 20.88 $1043.89 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 3.77 $94.17 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 17 17 40.05 $2002.62 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 10 11 10.00 $250.00 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 17 69.48 $3473.82 $50.00
CONOP -CONOP CONSULT, OT, PHONE 12 14 26.95 $673.75 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 7 5.55 $277.50 $50.00
CONPP -CONPP CONSULT, PT, PHONE 4 6 10.08 $252.08 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 26 34 130.19 $6509.41 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 13 14 21.62 $540.42 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 15 16 7856.00 $98200.00 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 133.57 $3339.29 $25.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 30 30 201.10 $10055.00 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 139 193 3132.51 $156625.33 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 26.43 $1321.43 $50.00
INTR -INTR INTERPRETER 10 11 25.18 $1258.93 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 72 101 1458.72 $99017.58 $67.88
OCCT -97530HM OT SESSION BY OT ASST 33 37 582.14 $31621.67 $54.32
PHY -97110 PT SESSION BY LICENSED PT 51 75 1210.00 $82134.64 $67.88
PHY -97110HM PT SESSION BY PT ASST 30 36 475.01 $25802.76 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 15 15 15.00 $15.00 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 1.50 $75.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 96 138 2408.03 $163457.35 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 40.86 $2219.36 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 50 64 1201.07 $15854.08 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 2 2 35.00 $3500.00 $100.00
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 2 2 15.21 $760.72 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 4 4 67.68 $3384.06 $50.00
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Subtotal (Total Children Is Unduplicated) 356 878 19244.90 $733676.49 $38.12
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Total 1528 20177.42 $794531.88 $39.38
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Number of Children (Unduplicated) With at Least One Authorization 434