Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 01/01/10 and 03/31/10 Date of Report: 05-17-10 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 2 2 2.00 $97.00 $48.50
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 2.00 $239.20 $119.60
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.00 $300.00 $75.00
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.00 $150.00 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 74 74 139.86 $10489.28 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 16 16 31.50 $2362.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 5.00 $277.50 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 7 12.50 $937.50 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 148 207 208.43 $10108.79 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 93 97 97.00 $4704.50 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 154 214 214.00 $10379.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 102 105 113.71 $5515.14 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 1 1 2.00 $100.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 380 545 545.00 $26432.50 $48.50
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Subtotal (Total Children Is Unduplicated) 614 1275 1379.00 $72092.91 $52.28
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 15.00 $22500.00 $1500.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 248 278 327.00 $16350.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 10 10 10.00 $250.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 427 578 917.69 $45884.40 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 1.00 $25.00 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 221 304 535.08 $26753.77 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 196 274 490.10 $24505.20 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 413 555 852.62 $42631.03 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 4 4 1.80 $45.00 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 480 653 4622.30 $231114.78 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 0.33 $16.67 $50.00
INTR -INTR INTERPRETER 19 23 377.06 $18853.12 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 192 285 2246.79 $152512.00 $67.88
PHY -97110 PT SESSION BY LICENSED PT 220 313 2414.83 $163918.46 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 169 199 199.00 $199.00 $1.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 2.00 $474.24 $237.12
SENS -V5264 EARMOLD 6 7 12.00 $224.64 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 370 535 3876.06 $263106.67 $67.88
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 3 3 28.43 $1421.43 $50.00
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Subtotal (Total Children Is Unduplicated) 946 4031 16929.08 $1010785.38 $59.71
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Total 5306 18308.08 $1082878.29 $59.15
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Number of Children (Unduplicated) With at Least One Authorization 969