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: 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
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 64 69 74.71 $3623.64 $48.50
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 2.04 $122.66 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.00 $93.60 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 4.00 $478.40 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 52 53 53.00 $2650.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 2 2 7.57 $378.57 $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 447 540 590.06 $28617.77 $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 324 389 388.06 $18820.77 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 537 640 724.86 $35155.57 $48.50
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Subtotal (Total Children Is Unduplicated) 940 1700 1848.30 $90038.00 $48.71
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.00 $1500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 18 18 48.83 $2441.67 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 62 72 97.07 $4853.34 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 3 3 4.39 $109.72 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 26 17.65 $882.50 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.02 $25.56 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 17 10.14 $507.22 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 44 50 44.42 $2220.80 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.79 $19.72 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 125 160 1345.79 $33644.69 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1047 1364 10941.50 $547075.08 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 1.00 $50.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 589 782 4966.03 $337093.90 $67.88
PHY -97110 PT SESSION BY LICENSED PT 483 646 4186.29 $284165.31 $67.88
PHY -97110HM PT SESSION BY PT ASST 1 1 13.14 $713.92 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 48 60 52.78 $52.78 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.00 $1000.00 $500.00
SENS -V5264 EARMOLD 2 2 6.98 $130.62 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 24 29 89.89 $4494.69 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 711 937 5673.63 $385125.68 $67.88
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 968 1438 8991.19 $4495.58 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 22 28 119.03 $5951.45 $50.00
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Subtotal (Total Children Is Unduplicated) 1438 5638 36614.55 $1616554.19 $44.15
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Total 7338 38462.85 $1706592.19 $44.37
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Number of Children (Unduplicated) With at Least One Authorization 1472