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: 10/01/09 and 12/31/09 Date of Report: 02-15-10 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 1 1 1.00 $60.00 $60.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 2.00 $100.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 75 76 152.00 $7600.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.00 $150.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.00 $150.00 $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 1 1 2.00 $111.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 73 74 143.00 $10725.00 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 43 44 78.00 $5850.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 13.03 $977.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 41 42 70.13 $3892.40 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 44 44 83.50 $6262.50 $75.00
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 2 2 2.00 $97.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 10 10 10.00 $485.00 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 17 17 21.13 $1024.97 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 21.55 $2155.25 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 4 4 4.00 $200.00 $50.00
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Subtotal (Total Children Is Unduplicated) 218 332 610.35 $40039.12 $65.60
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.00 $6000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 10 10 10.00 $500.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 10 9.50 $475.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 2.08 $52.08 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 19 19 24.07 $1203.34 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 5 5 7.86 $196.43 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 33 37 47.83 $2391.68 $50.00
CONOP -CONOP CONSULT, OT, PHONE 6 6 6.25 $156.25 $25.00
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.53 $63.33 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 35 37 47.87 $2393.57 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 3 3 6.46 $161.55 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 6 6 561.71 $7021.43 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 452.14 $11303.57 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 217 249 2023.99 $101199.64 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 8.14 $407.15 $50.00
INTR -INTR INTERPRETER 9 9 10.00 $500.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 70 85 532.81 $36167.46 $67.88
OCCT -97530HM OT SESSION BY OT ASST 21 23 157.67 $8564.72 $54.32
PHY -97110 PT SESSION BY LICENSED PT 59 72 594.12 $40328.93 $67.88
PHY -97110HM PT SESSION BY PT ASST 4 5 32.80 $1781.89 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 17 18 18.00 $18.00 $1.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 97 112 1071.93 $72762.62 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 86.29 $1139.04 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 6 44.00 $2200.01 $50.00
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Subtotal (Total Children Is Unduplicated) 391 735 5762.08 $296987.68 $51.54
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Total 1067 6372.43 $337026.79 $52.89
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Number of Children (Unduplicated) With at Least One Authorization 452