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: 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
Service Coordination, Class # 01
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 51 55 21.19 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 21 23 18.00 $666.00 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 1.12 $41.32 $37.00
TCON -TCON TRANSITION CONFERENCE 3 3 3.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 60 83 43.31 $707.32 $16.33
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 24 24 36.14 $1303.67 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 17 17 15.09 $905.33 $60.00
AUDE -V5090 DISPENSING FEE PER HEARING AID 19 20 19.04 $2277.71 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 3 3 13.29 $1660.71 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 9 9 12.70 $1587.50 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 24 25 48.62 $6076.98 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 6 6 6.00 $180.00 $30.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 4.00 $222.00 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 8.50 $637.50 $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 99 111 176.06 $8538.70 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 139 159 157.10 $7619.35 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 12 12 12.00 $600.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 405 476 512.48 $24855.06 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 3.07 $306.67 $100.00
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Subtotal (Total Children Is Unduplicated) 597 880 1029.08 $57116.68 $55.50
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 35 35 35.00 $1750.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 665 797 1668.30 $83414.94 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 71 79 145.69 $3642.27 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 14 42.64 $2131.99 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.23 $5.83 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 12.77 $638.34 $50.00
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.80 $120.00 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 670 813 1609.55 $80477.29 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 52 56 106.70 $2667.51 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 18 18 105.18 $7722.34 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 1.00 $12.50 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 6 79.00 $1975.00 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 13.14 $657.15 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 9.14 $457.15 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 6 6 67.71 $1692.86 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 790 997 8424.42 $421221.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 100 113 664.21 $45086.89 $67.88
OCCT -97530HM OT SESSION BY OT ASST 32 33 167.04 $9073.50 $54.32
PHY -97110 PT SESSION BY LICENSED PT 146 164 965.42 $65532.99 $67.88
PHY -97110HM PT SESSION BY PT ASST 61 63 403.07 $21894.84 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 2 2 2.00 $2.00 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 16 20 208.67 $10433.58 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 321 364 1731.62 $117542.37 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 14.71 $799.28 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 78 78 454.00 $5992.80 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 2.83 $283.33 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 862 1336 27707.20 $13853.58 $0.50
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Subtotal (Total Children Is Unduplicated) 1068 5012 44648.06 $902081.31 $20.20
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Total 5975 45720.45 $959905.32 $21.00
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Number of Children (Unduplicated) With at Least One Authorization 1093