Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2 2.00 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 6.64 $245.79 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 18.50 $684.50 $37.00
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Subtotal (Total Children Is Unduplicated) 4 6 27.14 $930.29 $34.27
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 147 159 156.43 $9386.09 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 6.00 $280.80 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 66 67 91.00 $10883.60 $119.60
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 6 6 6.00 $750.00 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 3 3.00 $166.50 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 1.00 $75.00 $75.00
NURS -NURS NURSING ASSESSMENT 8 8 26.00 $1300.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 17 19 19.38 $939.75 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 99 106 120.14 $5826.93 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 23 24 26.14 $1267.93 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 55 56 63.29 $3069.36 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 220 233 343.14 $16642.43 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.00 $100.00 $100.00
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Subtotal (Total Children Is Unduplicated) 450 692 865.53 $50867.75 $58.77
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.00 $1500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 17 20 38.66 $1932.87 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 17 21.11 $1055.42 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 5.13 $128.34 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 220 252 532.73 $26636.30 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 11 11 17.72 $442.92 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 121 142 274.13 $13706.39 $50.00
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.57 $164.17 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 46 55 97.20 $4860.01 $50.00
CONPP -CONPP CONSULT, PT, PHONE 3 3 1.09 $27.22 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 207 237 496.22 $24811.07 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 9 9 12.55 $313.75 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 74.29 $928.57 $12.50
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 12.86 $642.86 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 445 551 5093.04 $254651.96 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 7.00 $350.00 $50.00
INTR -INTR INTERPRETER 20 27 248.86 $12442.86 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 256 319 2987.15 $202767.47 $67.88
OCCT -97530HM OT SESSION BY OT ASST 23 26 212.90 $11564.57 $54.32
PHY -97110 PT SESSION BY LICENSED PT 166 225 1594.86 $108259.10 $67.88
PHY -97110HM PT SESSION BY PT ASST 8 9 110.46 $6000.42 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 43 44 42.50 $42.50 $1.00
SENS -FM FM RECEIVER HEARING AID 2 2 2.00 $3300.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 5 5 10.00 $5000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.00 $65.00 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 2.00 $228.00 $114.00
SENS -V5264 EARMOLD 10 13 14.66 $274.35 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 9 10 48.16 $2407.85 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 378 483 4017.31 $272695.26 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 2.71 $147.44 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 36 37 322.96 $4263.12 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 708 1190 262246.59 $131123.31 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 4 7 63.14 $3157.14 $50.00
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Subtotal (Total Children Is Unduplicated) 902 3710 278618.54 $1095890.22 $3.93
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Total 4408 279511.21 $1147688.26 $4.11
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Number of Children (Unduplicated) With at Least One Authorization 921