Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 125 131 131.00 $1391.22 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 122 128 128.00 $1130.24 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 122 130 130.00 $1404.00 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 122 128 128.00 $2789.12 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 108 114 114.00 $3223.92 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 107 121 126.40 $7584.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 19 19.00 $889.20 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 18 26.00 $3109.60 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 11 14 12.76 $638.06 $50.00
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 236 805 817.16 $22234.96 $27.21
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 27 102.00 $153000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 19 24 88.53 $4426.69 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 117 135 152.04 $7602.09 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 1.00 $25.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 4 4 2.13 $106.67 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 133 189 206.04 $10302.10 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 10.09 $504.52 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 190 257 277.53 $13876.71 $50.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 43 56 366.53 $9163.33 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 2 2 1.74 $87.22 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 6 6 45.33 $1133.33 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 348 562 4183.72 $209185.98 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 10 12 48.21 $2410.56 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 50 66 212.68 $10634.17 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 395 576 2210.54 $150051.79 $67.88
OCCT -97530HM OT SESSION BY OT ASST 76 81 444.22 $24129.86 $54.32
PHY -97110 PT SESSION BY LICENSED PT 506 739 2361.69 $160311.61 $67.88
PHY -97110HM PT SESSION BY PT ASST 89 92 446.55 $24256.59 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 162 171 171.00 $171.00 $1.00
SENS -FM FM RECEIVER HEARING AID 1 2 2.00 $3300.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 6.14 $3071.45 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 5.00 $325.00 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 7 8 16.00 $3793.92 $237.12
SENS -V5264 EARMOLD 17 24 47.00 $879.84 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 32 36 114.10 $5705.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 780 1137 4485.84 $304498.76 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 25.87 $1405.08 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 120 125 683.23 $9018.68 $13.20
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 7.60 $380.00 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 26 37 219.73 $10986.67 $50.00
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Subtotal (Total Children Is Unduplicated) 1428 4392 16944.12 $1124743.59 $66.38
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Total 5197 17761.28 $1146978.54 $64.58
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Number of Children (Unduplicated) With at Least One Authorization 1440