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: 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 1 1 1.00 $48.50 $48.50
AUDE -V5010 ASSESSMENT FOR HEARING AID 18 19 20.20 $945.36 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 18 18 18.00 $2152.80 $119.60
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 2.00 $97.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 2.00 $97.00 $48.50
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Subtotal (Total Children Is Unduplicated) 23 42 43.20 $3340.66 $77.33
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 7.00 $10500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 48 70 117.47 $5873.61 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 20 20.75 $1037.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 5 5 2.50 $62.50 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 8 10 16.30 $815.01 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 7 7 14.19 $354.67 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 39 57 91.85 $4592.32 $50.00
CONOP -CONOP CONSULT, OT, PHONE 5 6 7.16 $178.96 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 39 60.11 $3005.47 $50.00
CONPP -CONPP CONSULT, PT, PHONE 5 6 3.93 $98.13 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 26 44.89 $2244.53 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 11 11 13.87 $346.76 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 88 126 1821.36 $45533.94 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 1 1 2.86 $142.86 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 410 547 3839.84 $191992.25 $50.00
INTR -INTR INTERPRETER 44 51 199.35 $9967.39 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 199 267 1156.69 $78516.33 $67.88
OCCT -97530HM OT SESSION BY OT ASST 11 13 66.50 $3612.28 $54.32
PHY -97110 PT SESSION BY LICENSED PT 360 506 2487.15 $168827.63 $67.88
PHY -97110HM PT SESSION BY PT ASST 9 13 66.36 $3604.51 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 56 63 64.43 $64.43 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 18 18 18.00 $9000.00 $500.00
SENS -V5264 EARMOLD 18 18 7.14 $133.75 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 927 1283 6809.82 $462250.68 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 42 51 344.29 $4544.57 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.00 $100.00 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 14 15 834.57 $417.29 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 6 6 62.07 $3103.58 $50.00
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Subtotal (Total Children Is Unduplicated) 1404 3243 18181.44 $1010920.91 $55.60
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Total 3285 18224.64 $1014261.57 $55.65
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Number of Children (Unduplicated) With at Least One Authorization 1404