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: 07/01/09 and 09/30/09 Date of Report: 11-16-09 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 5 5 5.00 $300.00 $60.00
EXIT -EXIT TRANSITION ASSESSMENT 62 63 126.00 $6300.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 3.00 $225.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 3.00 $225.00 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.00 $150.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 5 8.00 $444.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 81 81 145.77 $10932.51 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 40 40 67.00 $5025.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 6.50 $487.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 63 63 114.13 $6334.40 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 59.00 $4425.00 $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 6 6 6.00 $291.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 13 13 16.57 $803.71 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 20 20 35.01 $1697.97 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 29.35 $2935.25 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.00 $100.00 $50.00
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Subtotal (Total Children Is Unduplicated) 210 343 630.33 $40773.34 $64.69
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.00 $7500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 6 6 6.00 $300.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 13 15.25 $762.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 3.61 $90.18 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 16 19 21.10 $1055.00 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 5 5 9.66 $241.58 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 23 30.80 $1540.00 $50.00
CONOP -CONOP CONSULT, OT, PHONE 6 7 8.31 $207.68 $25.00
CONPP -CONPP CONSULT, PT, PHONE 3 3 3.28 $82.08 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 29 37 42.77 $2138.34 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 4 4 13.31 $332.86 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 9 9 1532.43 $19155.36 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 128.57 $3214.29 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 213 248 2030.60 $101529.98 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 13.14 $657.15 $50.00
INTR -INTR INTERPRETER 3 3 6.00 $300.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 71 77 559.02 $37946.27 $67.88
OCCT -97530HM OT SESSION BY OT ASST 25 26 245.60 $13341.01 $54.32
PHY -97110 PT SESSION BY LICENSED PT 57 64 617.86 $41940.21 $67.88
PHY -97110HM PT SESSION BY PT ASST 5 6 41.86 $2273.68 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 20 24 33.00 $33.00 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 4.00 $200.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 105 125 1063.32 $72177.86 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 13 14 71.21 $940.03 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 5 40.79 $2039.29 $50.00
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Subtotal (Total Children Is Unduplicated) 388 728 6546.49 $309998.32 $47.35
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Total 1071 7176.82 $350771.66 $48.88
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Number of Children (Unduplicated) With at Least One Authorization 435