Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 1 1 1.00 $48.50 $48.50
AUDE -V5010 ASSESSMENT FOR HEARING AID 16 16 16.00 $748.80 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 16 16.00 $1913.60 $119.60
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.00 $125.00 $125.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 2.00 $97.00 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 2.00 $97.00 $48.50
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Subtotal (Total Children Is Unduplicated) 22 39 39.00 $3078.40 $78.93
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.00 $7500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 44 58 121.08 $6054.18 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 27 21.00 $1050.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.25 $6.25 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 11 12 33.28 $1664.05 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 10 12 15.14 $378.40 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 59 118.53 $5926.45 $50.00
CONOP -CONOP CONSULT, OT, PHONE 6 8 7.50 $187.50 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 46 52 95.40 $4770.14 $50.00
CONPP -CONPP CONSULT, PT, PHONE 5 7 7.98 $199.58 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 25 32 50.03 $2501.44 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 14 16 24.74 $618.42 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 109 133 2374.72 $59367.88 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 2 2 9.71 $485.72 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 449 577 4312.52 $215625.76 $50.00
INTR -INTR INTERPRETER 44 48 148.64 $7431.91 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 198 257 1163.65 $78988.56 $67.88
OCCT -97530HM OT SESSION BY OT ASST 13 16 123.71 $6720.17 $54.32
PHY -97110 PT SESSION BY LICENSED PT 333 454 2426.54 $164713.49 $67.88
PHY -97110HM PT SESSION BY PT ASST 14 21 89.00 $4834.49 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 41 44 44.80 $44.80 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 16 16 16.00 $8000.00 $500.00
SENS -V5264 EARMOLD 16 16 12.83 $240.24 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 906 1200 7123.22 $483524.09 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 36 45 253.79 $3349.97 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 6 6 200.71 $100.36 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 7 97.00 $4850.00 $50.00
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Subtotal (Total Children Is Unduplicated) 1438 3131 18896.77 $1069133.84 $56.58
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Total 3170 18935.77 $1072212.24 $56.62
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Number of Children (Unduplicated) With at Least One Authorization 1438