Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 311 346 502.00 $5331.24 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 274 299 299.00 $2640.17 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 275 301 302.00 $3261.60 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 268 295 295.00 $6428.05 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 248 271 272.00 $7692.16 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 236 321 494.10 $29646.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 33 55 55.23 $2584.92 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 41 47 66.00 $7893.60 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 41 64 67.09 $3354.45 $50.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.00 $75.00 $75.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 553 2004 2357.42 $69067.35 $29.30
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 68 88 309.00 $463500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 39 70 311.30 $15565.02 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 320 435 616.25 $30812.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 2.00 $50.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3 3 4.38 $219.17 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 1.00 $25.00 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 255 437 732.28 $36614.22 $50.00
CONOP -CONOP CONSULT, OT, PHONE 3 3 3.20 $80.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 36 59 102.57 $5128.33 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 358 606 1088.62 $54431.02 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 8 9 13.39 $334.72 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 10 10 80.53 $2013.33 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 76 100 1317.66 $32941.40 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 4 5 5.89 $294.45 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 61 71 462.37 $23118.62 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 8.13 $203.33 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 589 1345 15458.86 $772942.91 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 2.53 $126.67 $50.00
HERN -T1024HN *EI HEARING SERVICES AFTER SHINE 4 4 26.10 $1305.00 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 51 101 717.29 $35864.71 $50.00
INTR -INTR INTERPRETER 3 3 9.00 $450.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 664 1444 9320.98 $632708.42 $67.88
OCCT -97530HM OT SESSION BY OT ASST 60 65 128.23 $6965.62 $54.32
PHY -97110 PT SESSION BY LICENSED PT 803 1765 11245.60 $763351.40 $67.88
PHY -97110HM PT SESSION BY PT ASST 69 71 131.26 $7129.95 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 144 147 147.00 $147.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 10 14 26.00 $13000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 15 18.00 $1170.00 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 3 3 3.00 $342.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 12 14 25.00 $5928.00 $237.12
SENS -V5264 EARMOLD 29 51 101.67 $1903.20 $18.72
SHIN -T1024HN *INITIAL SHINE SERVICES, INDIVIDUAL 1 1 1.80 $90.00 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 43 76 452.98 $22649.17 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1260 2679 18649.20 $1265907.72 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 4 9.80 $532.34 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 96 101 217.57 $2871.88 $13.20
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 4 4 46.10 $2305.00 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 36 105 693.28 $34663.89 $50.00
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Subtotal (Total Children Is Unduplicated) 2120 9913 62489.83 $4237685.94 $67.81
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Total 11917 64847.26 $4306753.30 $66.41
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Number of Children (Unduplicated) With at Least One Authorization 2190