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: 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 1 1 1.00 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 6.50 $240.50 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 16.79 $621.07 $37.00
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Subtotal (Total Children Is Unduplicated) 3 4 24.29 $861.57 $35.48
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 2.00 $97.00 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 1.00 $54.38 $54.38
AUDE -AUDE UNSPECIFIED AUDE SERVICES 163 172 167.35 $10040.86 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 12 13.27 $620.88 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 74 78 98.87 $11824.64 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 6 6 12.29 $1535.71 $125.00
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 -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 35.60 $1780.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 2 2 2.00 $100.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 22 24 41.00 $1988.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 118 127 137.29 $6658.36 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 20 20 31.77 $1540.69 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 45 47 47.00 $2279.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 261 278 321.46 $15590.90 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 2.00 $200.00 $100.00
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Subtotal (Total Children Is Unduplicated) 506 791 924.88 $55388.98 $59.89
EI Services, Class # 03
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 2.14 $147.56 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 25 26 49.31 $2465.56 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 17 47.39 $2369.32 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 6.17 $154.17 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 254 301 618.82 $30941.04 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 17 18 23.47 $586.81 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 126 151 255.44 $12771.86 $50.00
CONOP -CONOP CONSULT, OT, PHONE 6 7 7.47 $186.81 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 52 67 104.41 $5220.52 $50.00
CONPP -CONPP CONSULT, PT, PHONE 4 4 3.98 $99.45 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 255 303 529.25 $26462.67 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 9 9 13.47 $336.81 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 2 2 89.29 $1116.07 $12.50
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 16.00 $800.00 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 496 619 5424.68 $271234.17 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 0.73 $36.67 $50.00
INTR -INTR INTERPRETER 20 25 225.98 $11299.17 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 282 356 3295.84 $223721.47 $67.88
OCCT -97530HM OT SESSION BY OT ASST 18 18 154.00 $8365.27 $54.32
PHY -97110 PT SESSION BY LICENSED PT 181 243 1683.89 $114302.17 $67.88
PHY -97110HM PT SESSION BY PT ASST 17 18 180.75 $9818.33 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 44 49 47.27 $47.27 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 6 6 11.00 $5500.00 $500.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 1.00 $237.12 $237.12
SENS -V5264 EARMOLD 16 16 22.91 $428.90 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 18 20 98.53 $4926.43 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 472 585 4753.33 $322655.77 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.00 $54.32 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 28 28 205.33 $2710.40 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 803 1481 512866.65 $256433.32 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 6 8 80.14 $4007.15 $50.00
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Subtotal (Total Children Is Unduplicated) 1004 4386 530819.64 $1319436.53 $2.49
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Total 5181 531768.81 $1375687.09 $2.59
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Number of Children (Unduplicated) With at Least One Authorization 1012