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: 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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1 1.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 1 1 1.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 1.00 $54.38 $54.38
AUDE -AUDE UNSPECIFIED AUDE SERVICES 3 3 3.00 $180.00 $60.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 19 20 31.00 $1550.00 $50.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 1.00 $55.50 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 61 62 98.14 $7360.72 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 34 34 49.50 $3712.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 29 29 40.00 $3000.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 82 82 123.18 $6836.28 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 12 12 18.00 $1350.00 $75.00
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 16 16 16.00 $776.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 10 10 10.00 $485.00 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 2 2 2.00 $100.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 14 14 14.00 $679.00 $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) 156 293 413.82 $26586.38 $64.25
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 6.00 $9000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 7 7 7.00 $350.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 13.64 $682.15 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.47 $11.67 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 19 22 36.55 $1827.50 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 12 12 13.14 $328.45 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 7 20.54 $1026.91 $50.00
CONOP -CONOP CONSULT, OT, PHONE 10 10 23.82 $595.48 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 2 0.75 $37.50 $50.00
CONPP -CONPP CONSULT, PT, PHONE 4 4 4.52 $112.92 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 26 27 60.48 $3023.82 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 13 13 17.92 $448.10 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 9 9 2753.14 $34414.28 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 133.57 $3339.29 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 150 176 1548.20 $77410.10 $50.00
INTR -INTR INTERPRETER 4 4 10.43 $521.43 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 71 82 572.20 $38840.63 $67.88
OCCT -97530HM OT SESSION BY OT ASST 20 21 236.42 $12842.57 $54.32
PHY -97110 PT SESSION BY LICENSED PT 53 64 492.83 $33453.39 $67.88
PHY -97110HM PT SESSION BY PT ASST 13 15 139.11 $7556.31 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 19 19 19.00 $19.00 $1.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 119 149 1324.22 $89887.79 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.14 $713.92 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 32 34 380.21 $5018.77 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.00 $100.00 $100.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 7 7 56.06 $2802.87 $50.00
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Subtotal (Total Children Is Unduplicated) 352 699 7884.35 $324364.82 $41.14
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Total 993 8299.17 $350951.20 $42.29
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Number of Children (Unduplicated) With at Least One Authorization 389