Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 1163 1196 1802.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 1163 1196 1802.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 7.00 $339.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 3.39 $122.24 $36.07
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 3.00 $48.90 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.00 $17.66 $8.83
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 3.00 $32.40 $10.80
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.00 $31.81 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 2 2.00 $42.68 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 8 8 7.23 $434.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 14 16.50 $772.20 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 17 21 24.00 $2870.40 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 15.00 $1875.00 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 19 19 19.00 $950.00 $50.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 22 23 23.00 $1276.50 $55.50
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 3.00 $145.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 74 76 79.00 $3831.50 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 3.00 $145.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 33 33 33.00 $1600.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 28 32 56.36 $2733.32 $48.50
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 1.00 $50.00 $50.00
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Subtotal (Total Children Is Unduplicated) 194 255 302.48 $17394.61 $57.51
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 23 24.00 $36000.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 3 4.07 $280.03 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.98 $205.04 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 31 42 286.40 $14319.93 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 3.00 $150.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 77 102 145.26 $7263.09 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 1.00 $25.00 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 99 135 198.58 $9929.05 $50.00
CONOP -CONOP CONSULT, OT, PHONE 3 3 3.00 $75.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 70 101.64 $5082.15 $50.00
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.00 $50.00 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 162 221 361.05 $18052.38 $50.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 48 54 387.64 $28460.74 $73.42
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 8.00 $200.00 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 6 28.29 $707.15 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 9 52.29 $2614.29 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 11 11 110.34 $5517.14 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 118 120 1850.92 $92545.95 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 764 1334 16742.84 $837142.03 $50.00
HERN -T1024HN *EI HEARING SERVICES AFTER SHINE 2 2 10.14 $507.15 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 4 4 50.79 $2539.29 $50.00
INTR -INTR INTERPRETER 6 9 39.71 $1985.72 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 974 2060 22046.62 $1496524.58 $67.88
OCCT -97530HM OT SESSION BY OT ASST 16 23 225.08 $12226.14 $54.32
PHY -97110 PT SESSION BY LICENSED PT 830 1698 21714.56 $1473984.40 $67.88
PHY -97110HM PT SESSION BY PT ASST 10 10 122.00 $6627.05 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 13 15 15.00 $15.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 16 21 23.00 $11500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 19 22 17.34 $1126.96 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 6 6 7.13 $1691.45 $237.12
SENS -V5264 EARMOLD 32 42 106.12 $1986.65 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 6 7 17.18 $858.81 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1840 3759 43455.92 $2949788.13 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 52.43 $2847.92 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 7 8 100.43 $1325.66 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 2 27.00 $1350.00 $50.00
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Subtotal (Total Children Is Unduplicated) 2507 9834 108343.75 $7025503.83 $64.84
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Total 11285 110448.23 $7042898.44 $63.77
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Number of Children (Unduplicated) With at Least One Authorization 2524