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: 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
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 101 102 102.00 $1083.24 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 97 98 98.00 $865.34 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 97 98 98.00 $1058.40 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 94 95 95.00 $2070.05 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 88 89 89.00 $2516.92 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 86 107 108.07 $6484.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 19 23 23.00 $1076.40 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 20 22 32.00 $3827.20 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 22 27 16.07 $803.34 $50.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.00 $75.00 $75.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 213 664 664.13 $19923.06 $30.00
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 23 77.00 $115500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 25 33 88.88 $4443.81 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 116 135 162.75 $8137.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 1.00 $25.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1 1 0.28 $14.17 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 133 183 180.90 $9045.22 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 13 13.58 $678.90 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 171 225 198.02 $9900.97 $50.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 41 47 342.67 $8566.68 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 2 2 0.80 $40.00 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 328 539 3948.36 $197417.93 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 2.53 $126.67 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 40 53 217.74 $10886.81 $50.00
INTR -INTR INTERPRETER 2 2 7.00 $350.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 397 555 2374.63 $161190.16 $67.88
OCCT -97530HM OT SESSION BY OT ASST 59 64 128.20 $6963.81 $54.32
PHY -97110 PT SESSION BY LICENSED PT 520 701 2667.89 $181096.46 $67.88
PHY -97110HM PT SESSION BY PT ASST 67 69 121.86 $6619.34 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 134 134 134.00 $134.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 6 6 12.00 $6000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 7 8.00 $520.00 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.00 $114.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 7 9 18.00 $4268.16 $237.12
SENS -V5264 EARMOLD 17 23 45.00 $842.40 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 30 33 117.85 $5892.50 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 748 1060 4561.43 $309630.10 $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 92 97 191.80 $2531.76 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 30 42 203.17 $10158.75 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1377 4063 15836.15 $1061627.41 $67.04
-----------------------------------------------------------------------------------------------------------------------------
Total 4727 16500.28 $1081550.46 $65.55
-----------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1396