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
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 4 4 4.00 $240.00 $60.00
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.00 $119.60 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 23 23 23.00 $1150.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 46 48 59.00 $2950.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.00 $300.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.50 $187.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 6.50 $360.75 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 243 246 417.43 $31307.15 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 175 181 259.43 $19457.15 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 106 106 138.03 $10352.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 335 349 519.00 $28804.23 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 63 66 88.50 $6637.50 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 7 7 36.72 $1781.10 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 28 30 30.00 $1455.00 $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 22 23 23.00 $1115.50 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 2 2 2.00 $100.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 52 57 63.86 $3097.07 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 3.00 $300.00 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.00 $100.00 $50.00
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Subtotal (Total Children Is Unduplicated) 533 1161 1685.97 $109953.99 $65.22
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 24 26 35.00 $52500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 12 12 15.33 $766.67 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 18 32.38 $1618.89 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 4.27 $106.67 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 35 44 88.53 $4426.42 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 17 19 32.32 $808.09 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 31 40 117.08 $5853.81 $50.00
CONOP -CONOP CONSULT, OT, PHONE 17 19 49.72 $1242.98 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 8 6.05 $302.50 $50.00
CONPP -CONPP CONSULT, PT, PHONE 4 6 10.08 $252.08 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 51 62 206.74 $10336.91 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 29 30 52.94 $1323.51 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 21 23 11015.43 $137692.85 $12.50
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 13.86 $346.43 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 133.57 $3339.29 $25.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 43 43 306.53 $15326.43 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 212 294 4816.29 $240814.66 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 3 46.50 $2325.00 $50.00
INTR -INTR INTERPRETER 13 18 32.68 $1633.93 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 121 180 2515.66 $170762.87 $67.88
OCCT -97530HM OT SESSION BY OT ASST 50 61 967.28 $52542.64 $54.32
PHY -97110 PT SESSION BY LICENSED PT 78 121 1801.41 $122279.43 $67.88
PHY -97110HM PT SESSION BY PT ASST 46 58 790.70 $42950.67 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 20 20 20.00 $20.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 1.00 $500.00 $500.00
SENS -V5264 EARMOLD 2 2 2.89 $54.11 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 1.50 $75.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 203 309 5137.70 $348747.12 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 51.36 $2789.72 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 89 112 2035.46 $26868.04 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 3 3 45.57 $4557.14 $100.00
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 2 2 15.21 $760.72 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 7 8 107.10 $5354.77 $50.00
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Subtotal (Total Children Is Unduplicated) 572 1557 30508.12 $1259279.32 $41.28
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Total 2721 32197.09 $1369233.31 $42.53
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Number of Children (Unduplicated) With at Least One Authorization 715