Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 -AUDE UNSPECIFIED AUDE SERVICES 154 169 163.08 $9784.81 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 19 19 19.00 $889.20 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 20 20 21.00 $2511.60 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 3 4.36 $544.64 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 6 6 17.86 $2232.14 $125.00
EXIT -EXIT TRANSITION ASSESSMENT 63 66 78.00 $3900.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 6 7.00 $525.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.00 $75.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 5.30 $397.50 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 5.80 $435.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 10 12.50 $693.75 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 5.29 $396.43 $75.00
NURS -NURS NURSING ASSESSMENT 1 1 6.00 $300.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 28 29 29.00 $1406.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 95 100 123.00 $5965.50 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 18 19 30.86 $1496.57 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 37 38 38.00 $1843.00 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 199 215 227.86 $11051.07 $48.50
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Subtotal (Total Children Is Unduplicated) 451 711 795.89 $44496.20 $55.91
EI Services, Class # 03
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.00 $68.86 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 29 34 65.96 $3297.95 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 17 28.14 $1407.22 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 148 170 331.88 $16593.87 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 12 13 7.81 $195.28 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 93 114 200.29 $10014.43 $50.00
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.29 $57.22 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 51 93.71 $4685.60 $50.00
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.56 $39.03 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 246 287 506.19 $25309.43 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 18 18 12.26 $306.53 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 2 2 229.71 $2871.43 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 8.00 $200.00 $25.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 8.43 $210.72 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 511 621 5390.74 $269536.95 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 10 10 21.54 $1076.92 $50.00
INTR -INTR INTERPRETER 44 50 354.60 $17729.86 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 228 296 2530.44 $171766.33 $67.88
OCCT -97530HM OT SESSION BY OT ASST 11 12 111.03 $6031.06 $54.32
PHY -97110 PT SESSION BY LICENSED PT 155 210 1592.59 $108104.88 $67.88
PHY -97110HM PT SESSION BY PT ASST 9 10 128.93 $7003.40 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 39 43 56.37 $56.37 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 8 8 13.00 $6500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 4.00 $260.00 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 1.00 $237.12 $237.12
SENS -V5264 EARMOLD 18 23 28.67 $536.76 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 27 31 130.43 $6521.67 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 366 477 3950.02 $268127.43 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 31.21 $1695.57 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 8 8 59.39 $783.98 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 807 1577 786051.14 $393025.58 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 15 18 99.02 $4951.19 $50.00
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Subtotal (Total Children Is Unduplicated) 912 4114 802051.36 $1329202.60 $1.66
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Total 4825 802847.25 $1373698.79 $1.71
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Number of Children (Unduplicated) With at Least One Authorization 920