Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -AUDE UNSPECIFIED AUDE SERVICES 8 11 11.00 $660.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.00 $46.80 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 16 17.00 $2033.20 $119.60
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 2 7.14 $892.86 $125.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 82 101 99.03 $4803.12 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 172 194 194.00 $9409.00 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 43 54 52.90 $2565.65 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 116 134 133.86 $6492.26 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 344 446 447.17 $21687.51 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 7.00 $700.00 $100.00
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Subtotal (Total Children Is Unduplicated) 454 962 971.10 $49317.50 $50.79
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 11 15.00 $22500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 4 4 4.17 $208.34 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 15 38.86 $1942.86 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.56 $13.96 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3 3 12.82 $641.19 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 8 26.14 $1306.78 $50.00
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.33 $33.13 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 11 33.31 $1665.72 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 9 33.36 $1667.97 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 4 6 16.27 $406.82 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 435.43 $10885.72 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 1452.29 $36307.14 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 23.43 $1171.43 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 156.43 $7821.43 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 22 23 184.39 $9219.59 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 125 188 3095.03 $154751.41 $50.00
HERN -T1024HN *EI HEARING SERVICES AFTER SHINE 1 1 11.29 $564.29 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 1.14 $57.15 $50.00
INTR -INTR INTERPRETER 1 2 12.14 $607.14 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 386 626 9456.53 $641909.54 $67.88
OCCT -97530HM OT SESSION BY OT ASST 17 18 213.93 $11620.61 $54.32
PHY -97110 PT SESSION BY LICENSED PT 208 346 4899.12 $332552.42 $67.88
PHY -97110HM PT SESSION BY PT ASST 15 16 88.40 $4802.06 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 2 2 6.30 $6.30 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.00 $1000.00 $500.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 2.00 $474.24 $237.12
SENS -V5264 EARMOLD 4 5 7.27 $136.03 $18.72
SHIN -T1024HN *INITIAL SHINE SERVICES, INDIVIDUAL 1 1 12.00 $600.00 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 3 3 87.57 $4378.58 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 629 957 13916.98 $944684.41 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 40 41 454.07 $5993.74 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 238 369 45511.39 $22755.70 $0.50
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 3 3 22.71 $1135.72 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 8 78.00 $3900.01 $50.00
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Subtotal (Total Children Is Unduplicated) 807 2699 80311.66 $2227721.34 $27.74
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Total 3661 81282.76 $2277038.84 $28.01
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Number of Children (Unduplicated) With at Least One Authorization 830