Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 4 4 4.00 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 5 85.14 $3150.29 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 7.93 $293.36 $37.00
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Subtotal (Total Children Is Unduplicated) 9 11 97.07 $3443.65 $35.48
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.00 $48.50 $48.50
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.00 $10.80 $10.80
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 5 7 7.00 $380.66 $54.38
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.00 $31.81 $31.81
AUDE -AUDE UNSPECIFIED AUDE SERVICES 281 328 382.93 $22975.71 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 6.73 $315.12 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 126 138 166.56 $19920.61 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 7 7 7.00 $875.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 24 26 41.43 $5178.58 $125.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 2.00 $150.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 1.00 $55.50 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 1.00 $75.00 $75.00
NURS -NURS NURSING ASSESSMENT 4 4 2.80 $140.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 3 4 4.00 $200.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 52 55 71.08 $3447.20 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 289 320 338.50 $16417.02 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 35 36 50.62 $2455.02 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 137 146 206.86 $10032.57 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 490 559 596.43 $28926.79 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.00 $100.00 $100.00
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Subtotal (Total Children Is Unduplicated) 871 1646 1890.93 $111810.89 $59.13
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 5.00 $7500.00 $1500.00
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 4.03 $277.73 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 42 49 202.27 $10113.73 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 27 109.21 $5460.49 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 9 11 31.27 $781.67 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 315 416 1473.60 $73679.75 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 55 62 175.34 $4383.48 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 202 291 782.70 $39134.78 $50.00
CONOP -CONOP CONSULT, OT, PHONE 35 39 109.38 $2734.59 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 88 272.02 $13601.13 $50.00
CONPP -CONPP CONSULT, PT, PHONE 16 19 74.46 $1861.54 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 307 407 1187.91 $59395.45 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 54 58 163.91 $4097.87 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 9.36 $687.00 $73.42
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 13.00 $325.00 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 5 37.14 $1857.14 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 1.14 $57.15 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 84 90 927.35 $46367.38 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 2 2 19.00 $475.00 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 665 997 16633.04 $831652.08 $50.00
HERN -T1024HN *EI HEARING SERVICES AFTER SHINE 1 1 3.03 $151.67 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 5 8 68.61 $3430.71 $50.00
INTR -INTR INTERPRETER 35 59 661.47 $33073.57 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 482 812 13165.53 $893676.51 $67.88
OCCT -97530HM OT SESSION BY OT ASST 86 104 1530.03 $83111.33 $54.32
PHY -97110 PT SESSION BY LICENSED PT 275 476 6522.77 $442765.95 $67.88
PHY -97110HM PT SESSION BY PT ASST 48 55 804.19 $43683.49 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 22 23 23.00 $23.00 $1.00
SENS -FM FM RECEIVER HEARING AID 4 4 4.00 $6600.00 $1650.00
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 1 1 1.00 $65.00 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 2 1.03 $245.02 $237.12
SENS -V5264 EARMOLD 19 24 82.79 $1549.80 $18.72
SHIN -T1024HN *INITIAL SHINE SERVICES, INDIVIDUAL 1 1 4.03 $201.67 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 13 15 100.20 $5010.25 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 619 995 14047.94 $953574.20 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 78.14 $4244.72 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 96 108 1598.95 $21106.08 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 2.00 $200.00 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1010 2163 529259.44 $264629.71 $0.50
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 1 1 2.29 $114.29 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 8 10 196.86 $9842.85 $50.00
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Subtotal (Total Children Is Unduplicated) 1403 7451 590402.46 $3877970.74 $6.57
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Total 9108 592390.46 $3993225.27 $6.74
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Number of Children (Unduplicated) With at Least One Authorization 1432