Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 04/01/09 and 06/30/09 Date of Report: 08-25-09 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 4.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 2 2 4.00 $0.00 $0.00
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 3 3 3.00 $180.00 $60.00
EXIT -EXIT TRANSITION ASSESSMENT 37 37 72.00 $3600.00 $50.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 2 2.00 $111.00 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 2.50 $187.50 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.00 $75.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 4.53 $251.60 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 90 90 162.00 $12150.00 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 52 52 84.50 $6337.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 25.00 $1875.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 92 92 183.03 $10158.35 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 32 60.50 $4537.50 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 5 5 5.00 $242.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 7 7 7.00 $339.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 13 13 13.00 $630.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 23 23 34.00 $1649.00 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 10.97 $1096.67 $100.00
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Subtotal (Total Children Is Unduplicated) 213 382 672.03 $43551.00 $64.80
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 7.00 $10500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 5 5 5.00 $250.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 11 12 11.50 $575.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 15 19 22.13 $1106.67 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 6 8 17.16 $429.01 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 17 19 21.38 $1069.17 $50.00
CONOP -CONOP CONSULT, OT, PHONE 6 8 9.57 $239.17 $25.00
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.22 $30.42 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 38 44 50.10 $2504.75 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 10 11 22.45 $561.19 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 10 11 1825.71 $22821.43 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 132.14 $3303.57 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 193 229 1783.27 $89163.56 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 5.14 $257.15 $50.00
INTR -INTR INTERPRETER 3 3 9.71 $485.72 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 81 90 709.76 $48178.31 $67.88
OCCT -97530HM OT SESSION BY OT ASST 22 27 198.57 $10786.39 $54.32
PHY -97110 PT SESSION BY LICENSED PT 62 72 642.39 $43605.54 $67.88
PHY -97110HM PT SESSION BY PT ASST 4 6 60.64 $3294.12 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 22 23 32.00 $32.00 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 13.00 $650.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 118 140 1201.63 $81566.50 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 17 17 252.41 $3331.87 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 6 7 19.05 $952.38 $50.00
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Subtotal (Total Children Is Unduplicated) 388 766 7052.94 $325693.89 $46.18
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Total 1150 7728.97 $369244.89 $47.77
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Number of Children (Unduplicated) With at Least One Authorization 442