Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01/01/09 and 03/31/09 Date of Report: 05-18-09 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.25 $9.25 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 7 7 9.00 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 2.00 $74.00 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 2.00 $74.00 $37.00
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Subtotal (Total Children Is Unduplicated) 8 11 13.25 $157.25 $11.87
Screening, Eval, and Assessment, Class # 02
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 1.00 $54.38 $54.38
AUDE -AUDE UNSPECIFIED AUDE SERVICES 3 3 3.00 $180.00 $60.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 4.00 $200.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 30 30 56.00 $2800.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 1.00 $75.00 $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 2 3 4.00 $222.00 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 2.00 $111.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 97 97 168.00 $12600.00 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 44 44 63.00 $4725.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 16 16 23.50 $1762.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 83 83 147.57 $8190.21 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 45 45 78.57 $5892.50 $75.00
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 6 7 7.00 $339.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 9 9 9.00 $436.50 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 2 2 2.00 $100.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 19 19 20.00 $970.00 $48.50
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Subtotal (Total Children Is Unduplicated) 191 366 592.64 $38830.60 $65.52
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 10.00 $15000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 6 6 6.00 $300.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 4 14.03 $701.67 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 12 15 35.54 $1777.15 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 11 12 22.24 $556.04 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 6.53 $326.67 $50.00
CONOP -CONOP CONSULT, OT, PHONE 8 8 20.09 $502.26 $25.00
CONPP -CONPP CONSULT, PT, PHONE 3 3 3.50 $87.50 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 30 60.80 $3039.77 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 14 15 30.16 $754.05 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 9 10 2183.29 $27291.07 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 257.14 $6428.57 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 163 182 1504.21 $75210.60 $50.00
INTR -INTR INTERPRETER 3 3 15.86 $792.86 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 74 88 689.07 $46773.80 $67.88
OCCT -97530HM OT SESSION BY OT ASST 20 22 167.91 $9120.85 $54.32
PHY -97110 PT SESSION BY LICENSED PT 58 60 506.03 $34349.08 $67.88
PHY -97110HM PT SESSION BY PT ASST 10 13 107.32 $5829.70 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 21 22 31.00 $31.00 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 6.86 $342.86 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 123 145 1202.32 $81613.31 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.00 $54.32 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 28 28 395.34 $5218.52 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.00 $100.00 $100.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 7 7 28.79 $1439.29 $50.00
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Subtotal (Total Children Is Unduplicated) 371 693 7306.02 $317640.91 $43.48
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Total 1070 7911.91 $356628.76 $45.07
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Number of Children (Unduplicated) With at Least One Authorization 416