Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 2.00 $72.14 $36.07
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.00 $28.28 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 5 5 5.00 $300.00 $60.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 7 9 12.00 $1500.00 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 13 15 16.00 $800.00 $50.00
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 91 116 116.00 $5626.00 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 2.00 $97.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 41 53 53.00 $2570.50 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 14 15 15.00 $750.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 150 173 173.23 $8401.82 $48.50
VISF -VISF VISION EVALUATION FUNCTIONAL 3 3 3.00 $150.00 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 266 396 401.23 $20442.74 $50.95
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 7 8.00 $12000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 7 8 16.00 $800.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 4.12 $205.84 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 165 206 349.30 $17465.25 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 95 134.46 $6723.03 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.40 $35.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 100 166.69 $8334.28 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 168 213 321.22 $16061.20 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.97 $24.17 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.02 $0.42 $25.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 12.86 $642.86 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 2 2 25.71 $642.86 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 276 401 2362.91 $118145.40 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 3 4 29.00 $1450.00 $50.00
INTR -INTR INTERPRETER 1 3 6.00 $300.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 123 169 1213.31 $82359.63 $67.88
OCCT -97530HM OT SESSION BY OT ASST 4 4 28.79 $1563.63 $54.32
PHY -97110 PT SESSION BY LICENSED PT 163 241 1407.72 $95556.20 $67.88
PHY -97110HM PT SESSION BY PT ASST 1 1 5.43 $294.88 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 6 6 4.82 $4.82 $1.00
SENS -V5264 EARMOLD 2 3 7.60 $142.27 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 4 4 24.14 $1207.14 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 427 612 3190.75 $216588.10 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 32.93 $434.66 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 532 1087 513375.93 $256687.97 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 17 20 59.64 $2982.14 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 634 3200 522789.72 $840651.73 $1.61
-----------------------------------------------------------------------------------------------------------------------------
Total 3596 523190.95 $861094.46 $1.65
-----------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 648