Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 42 45 19.26 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 26 19.50 $721.50 $37.00
TCON -TCON TRANSITION CONFERENCE 5 5 5.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 52 76 43.76 $721.50 $16.49
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 20 20 20.00 $721.40 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 28 28 28.00 $1680.00 $60.00
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 16 16.00 $1913.60 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 12.86 $1607.14 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 15 15 17.23 $2154.18 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 17 17 17.00 $2125.00 $125.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 7 7 7.00 $210.00 $30.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.00 $111.00 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 13 13 14.00 $1050.00 $75.00
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 138 149 181.01 $8778.97 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 159 181 181.00 $8778.50 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 12 12 12.00 $600.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 522 610 628.69 $30491.45 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 6.84 $684.29 $100.00
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Subtotal (Total Children Is Unduplicated) 706 1075 1145.63 $61002.52 $53.25
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 26 26 26.00 $1300.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.23 $61.67 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 706 867 1729.82 $86490.92 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 70 74 140.17 $3504.28 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 14 27.67 $1383.33 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.13 $53.33 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 8 13.77 $688.33 $50.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.53 $13.33 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 680 822 1640.04 $82002.06 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 68 74 127.15 $3178.81 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 23 26 214.73 $15765.72 $73.42
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 74.14 $1853.58 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 2.57 $128.57 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 4 4 44.14 $1103.57 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 804 1005 8275.43 $413771.36 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 126 141 853.93 $57964.72 $67.88
OCCT -97530HM OT SESSION BY OT ASST 16 16 95.00 $5160.40 $54.32
PHY -97110 PT SESSION BY LICENSED PT 156 174 1071.86 $72757.67 $67.88
PHY -97110HM PT SESSION BY PT ASST 31 33 139.00 $7550.48 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 2 2 2.00 $2.00 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 15 18 128.91 $6445.47 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 499 574 3035.18 $206028.28 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 49 49 180.50 $2382.60 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 3 3 15.70 $1570.47 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 875 1274 36400.83 $18200.43 $0.50
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Subtotal (Total Children Is Unduplicated) 1104 5215 54244.45 $992361.37 $18.29
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Total 6366 55433.84 $1054085.39 $19.02
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Number of Children (Unduplicated) With at Least One Authorization 1139