Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 36 50 63.14 $3062.43 $48.50
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 2 2.04 $122.66 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 4.00 $187.20 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 8.00 $956.80 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 74 78 104.86 $5242.86 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 4 5 5.14 $257.15 $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 422 564 598.71 $29037.60 $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 318 428 468.25 $22710.20 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 527 698 799.00 $38751.50 $48.50
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Subtotal (Total Children Is Unduplicated) 914 1835 2055.15 $100425.40 $48.87
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.00 $1500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 12 15 45.13 $2256.67 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 130 154 248.07 $12403.28 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 4 5 5.67 $141.67 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 57 72.44 $3622.23 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 2 0.80 $20.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 48 65.02 $3251.10 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 91 102 148.13 $7406.30 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.19 $79.72 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 122 196 974.72 $24367.90 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 976 1421 9653.81 $482690.72 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 1.00 $50.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 539 816 4458.24 $302625.04 $67.88
PHY -97110 PT SESSION BY LICENSED PT 452 694 3756.25 $254974.41 $67.88
PHY -97110HM PT SESSION BY PT ASST 1 1 5.86 $318.16 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 44 52 48.07 $48.07 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 2 4.00 $2000.00 $500.00
SENS -V5264 EARMOLD 3 4 7.07 $132.29 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 23 35 68.76 $3438.09 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 688 987 5164.16 $350543.12 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 4.07 $53.74 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 9.43 $942.86 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 878 1338 7926.60 $3963.29 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 20 32 140.35 $7017.65 $50.00
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Subtotal (Total Children Is Unduplicated) 1371 5968 32811.83 $1463846.30 $44.61
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Total 7803 34866.99 $1564271.69 $44.86
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Number of Children (Unduplicated) With at Least One Authorization 1407