Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 -AUDE UNSPECIFIED AUDE SERVICES 5 5 10.24 $614.29 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 16 16 17.33 $811.20 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 14.00 $1674.40 $119.60
EXIT -EXIT TRANSITION ASSESSMENT 2 2 2.00 $100.00 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 3.00 $145.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.00 $48.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 4 4 4.00 $194.00 $48.50
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Subtotal (Total Children Is Unduplicated) 30 45 51.57 $3587.88 $69.57
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 14 14.00 $21000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 38 46 79.55 $3977.48 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 50 53 66.00 $3300.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 8 8 8.00 $200.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 38 51 83.86 $4193.04 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 9 10 7.07 $176.67 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 88 112 161.06 $8053.22 $50.00
CONOP -CONOP CONSULT, OT, PHONE 17 20 21.07 $526.87 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 64 77 104.35 $5217.57 $50.00
CONPP -CONPP CONSULT, PT, PHONE 11 13 16.66 $416.46 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 87 101 127.31 $6365.25 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 16 17 19.78 $494.58 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 99 131 2092.86 $52321.43 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 398 508 3732.01 $186600.29 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 3 4 9.00 $450.00 $50.00
INTR -INTR INTERPRETER 19 25 91.86 $4592.85 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 226 297 1489.23 $101089.04 $67.88
OCCT -97530HM OT SESSION BY OT ASST 24 28 160.93 $8741.65 $54.32
PHY -97110 PT SESSION BY LICENSED PT 312 420 2429.59 $164920.28 $67.88
PHY -97110HM PT SESSION BY PT ASST 17 21 78.47 $4262.31 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 31 33 35.13 $35.13 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 12 12 12.00 $6000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.00 $65.00 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 1.00 $237.12 $237.12
SENS -V5264 EARMOLD 15 15 8.43 $157.87 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 770 1009 6672.14 $452904.52 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 17.07 $927.32 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 70 72 377.57 $4983.98 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 2 2 1.63 $163.33 $100.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 9 11 49.93 $2496.44 $50.00
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Subtotal (Total Children Is Unduplicated) 1255 3115 17968.56 $1044869.68 $58.15
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Total 3160 18020.13 $1048457.57 $58.18
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Number of Children (Unduplicated) With at Least One Authorization 1256