Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 2 2 0.70 $42.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 12 11.06 $517.40 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 11 11.00 $1315.60 $119.60
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 10 10 10.00 $485.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 3 3 3.00 $145.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 6 6 6.00 $291.00 $48.50
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Subtotal (Total Children Is Unduplicated) 31 44 41.76 $2796.50 $66.97
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 6.00 $9000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 36 47 85.95 $4297.48 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 48 71.14 $3557.15 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 5 7 6.00 $150.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 27 29 58.21 $2910.47 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 8 13 7.41 $185.21 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 62 69 118.54 $5927.02 $50.00
CONOP -CONOP CONSULT, OT, PHONE 11 13 11.76 $293.96 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 51 87.72 $4385.76 $50.00
CONPP -CONPP CONSULT, PT, PHONE 8 10 9.16 $228.96 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 58 66 97.28 $4863.79 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 17 20 17.26 $431.46 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 95 127 1959.57 $48989.28 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 1 1 5.86 $292.86 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 440 572 3922.66 $196132.98 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 3 3 7.67 $383.34 $50.00
INTR -INTR INTERPRETER 23 24 79.50 $3975.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 207 264 1378.43 $93567.95 $67.88
OCCT -97530HM OT SESSION BY OT ASST 27 32 202.06 $10975.87 $54.32
PHY -97110 PT SESSION BY LICENSED PT 309 423 2167.66 $147140.69 $67.88
PHY -97110HM PT SESSION BY PT ASST 23 30 130.74 $7101.69 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 34 35 40.90 $40.90 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 11 11 11.00 $5500.00 $500.00
SENS -V5264 EARMOLD 11 11 7.77 $145.39 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 814 1092 6236.22 $423314.55 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 6.79 $368.60 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 90 107 610.35 $8056.59 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.00 $100.00 $100.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 7 10 60.56 $3027.98 $50.00
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Subtotal (Total Children Is Unduplicated) 1365 3124 17405.14 $985344.89 $56.61
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Total 3168 17446.89 $988141.40 $56.64
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Number of Children (Unduplicated) With at Least One Authorization 1366