Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 59 70 38.48 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 38 46 33.00 $1221.00 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 3.11 $114.91 $37.00
TCON -TCON TRANSITION CONFERENCE 4 4 4.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 76 123 78.59 $1335.91 $17.00
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.32 $15.68 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 24 24 41.86 $1509.79 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 73 75 169.08 $10144.66 $60.00
AUDE -V5090 DISPENSING FEE PER HEARING AID 30 32 33.02 $3949.46 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 3 3 13.29 $1660.71 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 13 13 23.99 $2998.21 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 42 45 79.84 $9979.46 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 26 26 26.00 $780.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.06 $4.58 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.27 $20.42 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 6.50 $360.75 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 18 20.00 $1500.00 $75.00
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 2 2.00 $97.00 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 149 179 326.43 $15831.86 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 2.00 $97.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 204 248 270.87 $13137.09 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 26 26 26.00 $1300.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 608 776 975.33 $47303.67 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 5.47 $546.67 $100.00
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Subtotal (Total Children Is Unduplicated) 919 1481 2024.32 $111437.02 $55.05
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 38 38 38.00 $1900.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 7 40.55 $2027.62 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 5 5 18.20 $455.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 844 1077 4160.75 $208037.41 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 187 212 889.92 $22248.09 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 22 134.63 $6731.75 $50.00
CONOP -CONOP CONSULT, OT, PHONE 6 7 25.90 $647.50 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 24 113.63 $5681.67 $50.00
CONPP -CONPP CONSULT, PT, PHONE 4 5 19.70 $492.50 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 973 1303 5115.02 $255750.78 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 201 240 955.43 $23885.85 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 45 48 456.02 $33480.77 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 3 3 746.71 $9333.93 $12.50
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 6.86 $171.43 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 28 486.86 $12171.44 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 23.86 $1192.86 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 30.14 $1507.14 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 156 162 1111.86 $55592.85 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 7 7 92.29 $2307.15 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1258 1851 29643.44 $1482171.96 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 179 234 2131.55 $144689.51 $67.88
OCCT -97530HM OT SESSION BY OT ASST 75 82 850.88 $46219.86 $54.32
PHY -97110 PT SESSION BY LICENSED PT 272 347 3398.87 $230715.49 $67.88
PHY -97110HM PT SESSION BY PT ASST 97 101 1297.93 $70503.50 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 2 2 2.00 $2.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.00 $1000.00 $500.00
SHIN -T1024HN *INITIAL SHINE SERVICES, INDIVIDUAL 1 1 11.43 $571.43 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 21 34 565.93 $28296.67 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 614 776 5631.94 $382295.94 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 81.29 $4415.44 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 151 173 1885.43 $24887.63 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 4 4 65.40 $6540.48 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1384 2607 55037.43 $27518.69 $0.50
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Subtotal (Total Children Is Unduplicated) 1748 9413 115073.85 $3096444.32 $26.91
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Total 11017 117176.76 $3209217.24 $27.39
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Number of Children (Unduplicated) With at Least One Authorization 1782