Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.00 $28.28 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 6 6 11.22 $673.33 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 4.00 $187.20 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 6.67 $797.34 $119.60
EXIT -EXIT TRANSITION ASSESSMENT 119 124 301.00 $15050.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.00 $450.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.00 $300.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 6 12.00 $666.00 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 33 33 66.00 $3663.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 132 133 264.00 $19800.00 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 45.00 $3375.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 70 70 140.00 $10500.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 141 141 280.00 $15540.00 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 28.00 $2100.00 $75.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 49 49 57.00 $2764.50 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 2.00 $97.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 15 15 15.00 $727.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 44 45 64.57 $3131.71 $48.50
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 3.00 $145.50 $48.50
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Subtotal (Total Children Is Unduplicated) 379 674 1310.46 $79996.36 $61.04
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 51 54 74.00 $111000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 12 12 98.62 $4930.95 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 521 1135 2350.71 $117535.72 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 529 598 1278.94 $63947.15 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 221 242 485.80 $24290.00 $50.00
CONOP -CONOP CONSULT, OT, PHONE 5 5 9.00 $225.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 290 316 636.80 $31840.00 $50.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.00 $50.00 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 425 476 955.30 $47765.00 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 7 7 14.00 $350.00 $25.00
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 15 18 174.51 $4362.85 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 31 40 314.24 $7855.95 $25.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 54 62 548.98 $27449.02 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 4 5 26.26 $656.43 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 437 494 4246.80 $212340.12 $50.00
INTR -INTR INTERPRETER 14 16 45.71 $2285.71 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 108 118 804.46 $54606.57 $67.88
OCCT -97530HM OT SESSION BY OT ASST 7 7 44.39 $2411.03 $54.32
PHY -97110 PT SESSION BY LICENSED PT 161 186 999.89 $67872.29 $67.88
PHY -97110HM PT SESSION BY PT ASST 8 8 30.00 $1629.35 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 65 65 96.00 $96.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 4.00 $2000.00 $500.00
SENS -V5264 EARMOLD 8 8 17.26 $323.02 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 2.00 $100.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 275 328 2260.46 $153439.76 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 27 29 210.70 $2781.30 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 2 2 9.14 $914.29 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 571 865 28620.69 $14310.35 $0.50
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Subtotal (Total Children Is Unduplicated) 638 5100 44360.65 $957367.83 $21.58
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Total 5774 45671.11 $1037364.20 $22.71
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Number of Children (Unduplicated) With at Least One Authorization 676