Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 1 1 1.00 $48.50 $48.50
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 9 14 9.73 $158.56 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 18 26 15.91 $140.44 $8.83
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 27 17.84 $192.72 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 18 24 16.17 $352.39 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 10 10 6.72 $365.55 $54.38
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 12 8.05 $256.06 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 1 1 0.02 $0.47 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 9 10 16.98 $1018.67 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 8 8.00 $374.40 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 9 9.00 $1076.40 $119.60
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 29 30 53.29 $2957.36 $55.50
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Subtotal (Total Children Is Unduplicated) 57 172 162.71 $6941.53 $42.66
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 8.00 $12000.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.02 $70.39 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 24 35 68.47 $3423.33 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 72 88 95.93 $4796.56 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 106 115 131.60 $6579.89 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 70 95.14 $4757.15 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 144 169 184.03 $9201.56 $50.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 2 2.00 $146.84 $73.42
EIIF -COUN UNSPECIFIED COUNSELING 1 1 1.00 $50.00 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 619 925 5765.23 $288261.56 $50.00
INTR -INTR INTERPRETER 6 8 8.00 $400.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 658 966 6082.42 $412874.96 $67.88
OCCT -97530HM OT SESSION BY OT ASST 7 8 40.57 $2203.84 $54.32
PHY -97110 PT SESSION BY LICENSED PT 606 876 5666.24 $384624.43 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 31 34 34.00 $34.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 7 7 7.00 $3500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 4.50 $292.77 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 3.00 $711.36 $237.12
SENS -V5264 EARMOLD 25 34 42.71 $799.58 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 19 21 28.30 $1415.24 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1183 1805 11682.80 $793028.31 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 8 8 42.00 $554.40 $13.20
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Subtotal (Total Children Is Unduplicated) 1801 5190 29993.98 $1929726.16 $64.34
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Total 5362 30156.69 $1936667.69 $64.22
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Number of Children (Unduplicated) With at Least One Authorization 1801