Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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
Service Coordination, Class # 01
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 5 5 1.73 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 5 5 1.73 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 55 57 57.00 $3420.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.00 $93.60 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 11 12.00 $1435.20 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 10 10 10.00 $1250.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 3.00 $375.00 $125.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 227 245 245.00 $11882.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 236 267 267.00 $12949.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 748 838 885.00 $42922.50 $48.50
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Subtotal (Total Children Is Unduplicated) 933 1433 1481.00 $74328.30 $50.19
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 38 38 37.82 $1891.11 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 789 905 2194.65 $109732.33 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 37 41 84.01 $2100.35 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 12 13 22.78 $1138.90 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 11 16.85 $842.70 $50.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.14 $28.57 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 770 876 2122.06 $106102.75 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 41 44 97.67 $2441.85 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 17 17 224.00 $16446.08 $73.42
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 10 61.14 $1528.57 $25.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 8 8 78.00 $1950.01 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 849 978 8594.23 $429711.53 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 2.57 $128.57 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 192 215 1218.08 $82683.29 $67.88
OCCT -97530HM OT SESSION BY OT ASST 31 31 174.57 $9482.71 $54.32
PHY -97110 PT SESSION BY LICENSED PT 222 246 1405.25 $95388.39 $67.88
PHY -97110HM PT SESSION BY PT ASST 30 30 153.79 $8353.64 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 10 11 8.43 $8.43 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 3.00 $1500.00 $500.00
SENS -V5264 EARMOLD 2 2 3.00 $56.16 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 14 16 141.29 $7064.29 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 784 892 5152.52 $349752.74 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.14 $713.92 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 37 38 249.43 $3292.46 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 12.57 $1257.14 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 917 1205 16930.28 $8465.12 $0.50
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Subtotal (Total Children Is Unduplicated) 1306 5633 39002.27 $1242061.60 $31.85
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Total 7071 40485.01 $1316389.90 $32.52
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Number of Children (Unduplicated) With at Least One Authorization 1326