Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 280 310 388.60 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 280 310 388.60 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.31 $3.36 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.31 $6.78 $21.79
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 9 11.29 $1350.67 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 17 17 17.00 $850.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 3.07 $230.36 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 3.00 $225.00 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.57 $42.86 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 7.50 $416.25 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 71 71 162.00 $12150.00 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 42 42 75.50 $5662.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 24 24 45.00 $3375.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 113 113 237.50 $13181.25 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 18 33.00 $2475.00 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 241 425 450.25 $21837.28 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 215 223 230.43 $11175.79 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 257 488 521.71 $25303.14 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 207 219 219.00 $10621.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 796 1343 1356.21 $65776.39 $48.50
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Subtotal (Total Children Is Unduplicated) 1078 3007 3373.67 $174683.12 $51.78
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 6.00 $9000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 3.09 $154.52 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 302 370 471.62 $23581.19 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 30 32 38.00 $950.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 455 735 2902.24 $145112.05 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 158 239 952.53 $47626.26 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 144 223 899.90 $44994.83 $50.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.30 $57.50 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 448 687 2544.20 $127210.22 $50.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 6.90 $506.60 $73.42
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 139 140 840.76 $42038.10 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 670 1154 16671.12 $833555.83 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 3 3 18.76 $937.86 $50.00
INTR -INTR INTERPRETER 31 55 373.20 $18659.97 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 339 654 8486.34 $576052.61 $67.88
PHY -97110 PT SESSION BY LICENSED PT 372 738 9737.70 $660994.89 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 62 67 70.18 $70.18 $1.00
SENS -FM FM RECEIVER HEARING AID 1 1 1.00 $1650.00 $1650.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 6 7 71.14 $16869.40 $237.12
SENS -V5264 EARMOLD 9 12 19.00 $355.68 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 797 1389 17733.02 $1203717.23 $67.88
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 10 16 231.78 $11588.81 $50.00
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Subtotal (Total Children Is Unduplicated) 1357 6531 62082.77 $3765911.71 $60.66
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Total 9848 65845.03 $3940594.83 $59.85
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Number of Children (Unduplicated) With at Least One Authorization 1385