Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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
TCM -T1017TL TARGETED CASE MANAGEMENT 27 28 30.48 $1127.76 $37.00
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Subtotal (Total Children Is Unduplicated) 27 28 30.48 $1127.76 $37.00
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 3.00 $145.50 $48.50
AUDE -AUDE UNSPECIFIED AUDE SERVICES 15 24 120.69 $7241.29 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 29 33.66 $1575.08 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 27 49.39 $5907.38 $119.60
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 26.29 $3285.71 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 362 448 582.43 $29121.43 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 1 1 1.00 $50.00 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 29 29 29.00 $1406.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 8 9 9.00 $436.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 17 17 17.00 $824.50 $48.50
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Subtotal (Total Children Is Unduplicated) 433 590 871.45 $49993.90 $57.37
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 41 52 54.71 $82071.45 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 54 84 256.03 $12801.63 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 187 238 318.43 $15921.43 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 9 12 12.00 $300.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 90 123 302.67 $15133.29 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 14 18 35.40 $885.06 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 161 215 477.72 $23885.93 $50.00
CONOP -CONOP CONSULT, OT, PHONE 26 33 59.08 $1477.12 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 111 139 303.54 $15176.99 $50.00
CONPP -CONPP CONSULT, PT, PHONE 17 24 32.98 $824.58 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 166 200 487.45 $24372.66 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 33 44 76.00 $1899.91 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 32 32 785.86 $19646.43 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 150 212 5738.33 $143458.35 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 72.14 $3607.15 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 147 149 1625.70 $81284.75 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 32.86 $821.43 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 744 1264 20122.25 $1006112.31 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 4 7 18.47 $923.33 $50.00
INTR -INTR INTERPRETER 64 86 567.46 $28373.21 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 629 1259 12194.51 $827763.05 $67.88
OCCT -97530HM OT SESSION BY OT ASST 43 57 481.57 $26158.70 $54.32
PHY -97110 PT SESSION BY LICENSED PT 704 1422 14748.73 $1001143.98 $67.88
PHY -97110HM PT SESSION BY PT ASST 26 26 115.88 $6294.72 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 28 33 36.23 $36.23 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 17 19 18.50 $9250.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.00 $65.00 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 1.00 $237.12 $237.12
SENS -V5264 EARMOLD 22 25 28.35 $530.67 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1503 2884 34275.72 $2326636.05 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 15 19 134.64 $7313.40 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 48 55 559.36 $7383.52 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 21 47 68.10 $6810.02 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1 1 2.00 $1.00 $0.50
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 13 13 76.00 $3800.00 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 26 42 803.21 $40160.61 $50.00
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Subtotal (Total Children Is Unduplicated) 2072 8838 94923.88 $5742561.05 $60.50
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Total 9456 95825.81 $5793682.70 $60.46
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Number of Children (Unduplicated) With at Least One Authorization 2080