Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 103 103 96.23 $1022.00 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 93 93 87.20 $769.97 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.03 $28.00 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 93 93 87.20 $941.76 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 94 94 87.23 $1900.81 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 83 83 77.20 $2183.21 $28.28
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 2 2.00 $42.68 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 128 143 142.30 $8537.99 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 9 9.00 $421.20 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 24.50 $2930.76 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 5 5 4.14 $206.95 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 57 63 63.37 $3073.29 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 14 17 17.00 $824.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 53 63 63.67 $3087.84 $48.50
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Subtotal (Total Children Is Unduplicated) 328 784 762.08 $25970.94 $34.08
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 33 147.00 $220500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 20 22 73.49 $3674.54 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 112 140 162.53 $8126.67 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.50 $12.50 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 12 13 6.81 $340.41 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 106 147 86.18 $4308.91 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 7 5.82 $291.11 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 218 269 184.75 $9237.28 $50.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 44 59 320.13 $8003.34 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 11 12 8.93 $446.67 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 1.00 $50.00 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 404 597 4553.90 $227694.97 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 27 32 73.62 $3680.98 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 45 62 137.63 $6881.67 $50.00
INTR -INTR INTERPRETER 1 1 3.00 $150.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 388 587 2582.90 $175327.30 $67.88
OCCT -97530HM OT SESSION BY OT ASST 2 2 7.87 $427.32 $54.32
PHY -97110 PT SESSION BY LICENSED PT 596 883 3000.83 $203696.03 $67.88
PHY -97110HM PT SESSION BY PT ASST 2 2 4.67 $253.50 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 210 244 244.00 $244.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 3 3 6.00 $3000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 2.00 $130.00 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 5 5 9.00 $2134.08 $237.12
SENS -V5264 EARMOLD 17 22 44.00 $823.68 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 24 38 93.28 $4663.75 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 832 1244 4905.58 $332990.90 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 8.07 $438.18 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 6.40 $84.48 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 29 42 207.84 $10392.08 $50.00
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Subtotal (Total Children Is Unduplicated) 1538 4476 16887.72 $1228004.33 $72.72
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Total 5260 17649.80 $1253975.27 $71.05
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Number of Children (Unduplicated) With at Least One Authorization 1566