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: 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
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.00 $48.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 2.00 $72.14 $36.07
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.52 $4.61 $8.83
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.52 $5.64 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.52 $11.38 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.52 $43.05 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 6 7 7.00 $420.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.00 $46.80 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.69 $201.99 $119.60
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 6 7 8.00 $1000.00 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 3 3 4.00 $200.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 16 16 17.00 $850.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 109 139 139.00 $6741.50 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 42 54 54.00 $2619.00 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 36 39 39.00 $1950.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 166 197 196.25 $9518.13 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.00 $100.00 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 4 4 4.00 $200.00 $50.00
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Subtotal (Total Children Is Unduplicated) 315 478 480.03 $24129.73 $50.27
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 6 8.00 $12000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 6 8 26.97 $1348.33 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 4 7.18 $359.17 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 168 223 396.97 $19848.52 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 80 102 165.88 $8294.15 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.22 $5.42 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 86 107 193.95 $9697.47 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 174 232 400.44 $20022.03 $50.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.52 $37.92 $25.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.14 $7.15 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 2 2 18.14 $453.57 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 303 428 2562.03 $128101.50 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 4 4 39.14 $1957.15 $50.00
INTR -INTR INTERPRETER 1 1 3.00 $150.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 149 189 1267.45 $86034.54 $67.88
OCCT -97530HM OT SESSION BY OT ASST 4 4 33.93 $1843.00 $54.32
PHY -97110 PT SESSION BY LICENSED PT 174 240 1468.71 $99695.83 $67.88
PHY -97110HM PT SESSION BY PT ASST 2 2 4.57 $248.32 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 7 8 4.24 $4.24 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.00 $1000.00 $500.00
SENS -V5264 EARMOLD 3 5 10.42 $195.10 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 4 4 19.86 $992.86 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 440 678 3349.56 $227368.26 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.71 $147.44 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 48.61 $641.61 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 594 1191 547782.00 $273891.00 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 15 19 52.03 $2601.68 $50.00
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Subtotal (Total Children Is Unduplicated) 680 3472 557869.68 $896946.24 $1.61
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Total 3950 558349.71 $921075.97 $1.65
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Number of Children (Unduplicated) With at Least One Authorization 709