Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 8.00 $956.80 $119.60
EXIT -EXIT TRANSITION ASSESSMENT 4 5 8.00 $400.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.00 $150.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.00 $150.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 6.00 $333.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 88 88 173.55 $13016.25 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 42.00 $3150.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 19 19 33.50 $2512.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 93 93 180.55 $10020.53 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 16.00 $1200.00 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 141 186 193.43 $9381.29 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 84 84 84.00 $4074.00 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 141 182 193.86 $9402.07 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 96 97 97.00 $4704.50 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 1 1 1.00 $50.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 453 572 573.00 $27790.50 $48.50
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 649 1372 1614.89 $87366.43 $54.10
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 1.94 $96.99 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 184 208 284.00 $14200.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 7 7 7.00 $175.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 298 363 725.85 $36292.51 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 2.30 $57.50 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 117 148 291.93 $14596.68 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 112 153 298.94 $14946.97 $50.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.00 $75.00 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 295 359 671.86 $33592.75 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 410 509 4004.81 $200240.64 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 4.64 $232.15 $50.00
INTR -INTR INTERPRETER 12 17 79.22 $3960.83 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 196 265 2097.91 $142405.86 $67.88
PHY -97110 PT SESSION BY LICENSED PT 216 284 2372.25 $161028.23 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 114 120 118.81 $118.81 $1.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 4 4 8.00 $1896.96 $237.12
SENS -V5264 EARMOLD 7 7 14.00 $262.08 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 474 616 4384.69 $297632.56 $67.88
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 3 4 28.64 $1432.14 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 868 3070 15401.79 $926243.64 $60.14
-----------------------------------------------------------------------------------------------------------------------------
Total 4442 17016.67 $1013610.07 $59.57
-----------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 900