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: 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 -V5090 DISPENSING FEE PER HEARING AID 3 3 4.20 $502.00 $119.60
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 2.07 $155.36 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.00 $75.00 $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 2 2 2.50 $138.75 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 40 40 94.79 $7108.93 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 11.50 $862.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 9.00 $675.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 40 40 93.79 $5205.11 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 12 12 21.50 $1612.50 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 133 164 176.14 $8542.93 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 103 106 106.00 $5141.00 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 141 185 202.57 $9824.71 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 93 95 95.00 $4607.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 439 548 552.00 $26772.00 $48.50
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Subtotal (Total Children Is Unduplicated) 621 1211 1372.63 $71266.13 $51.92
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 3.02 $151.24 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 169 193 247.34 $12366.91 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 15 16 20.00 $500.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 279 349 744.61 $37230.33 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 107 126 279.15 $13957.75 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 100 124 263.90 $13195.13 $50.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.30 $57.50 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 269 337 653.07 $32653.73 $50.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.83 $61.18 $73.42
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 412 514 4272.43 $213621.73 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 6.57 $328.57 $50.00
INTR -INTR INTERPRETER 8 10 81.00 $4050.13 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 196 263 2162.55 $146793.71 $67.88
PHY -97110 PT SESSION BY LICENSED PT 212 288 2340.03 $158840.93 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 60 65 62.91 $62.91 $1.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 45.14 $10704.28 $237.12
SENS -V5264 EARMOLD 3 4 8.00 $149.76 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 444 562 4465.55 $303121.20 $67.88
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 3 4 21.86 $1092.86 $50.00
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Subtotal (Total Children Is Unduplicated) 823 2864 15684.27 $952167.83 $60.71
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Total 4076 17057.90 $1023433.96 $60.00
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Number of Children (Unduplicated) With at Least One Authorization 833