Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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
Service Coordination, Class # 01
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2 0.16 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 2 2 0.16 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 58 58 57.30 $3438.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 3.00 $140.40 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 21 21 23.00 $2750.80 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 5 5 5.00 $625.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 4 4 4.00 $500.00 $125.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 225 253 253.00 $12270.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 248 279 279.00 $13531.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 766 865 940.22 $45600.62 $48.50
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Subtotal (Total Children Is Unduplicated) 958 1487 1564.52 $78856.82 $50.40
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.00 $6000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 28 28 28.93 $1446.43 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 677 730 1679.77 $83988.67 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 47 50 118.95 $2973.86 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 25 50.15 $2507.62 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.14 $3.47 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 18 26.77 $1338.33 $50.00
CONPP -CONPP CONSULT, PT, PHONE 2 2 7.06 $176.55 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 766 878 1836.15 $91807.28 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 56 58 116.81 $2920.25 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 11 118.00 $8663.56 $73.42
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 20 21 158.14 $3953.57 $25.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 6 7 42.57 $1064.29 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 874 1029 8561.08 $428053.89 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 194 223 1212.29 $82290.02 $67.88
OCCT -97530HM OT SESSION BY OT ASST 55 57 264.93 $14390.94 $54.32
PHY -97110 PT SESSION BY LICENSED PT 211 239 1281.65 $86998.55 $67.88
PHY -97110HM PT SESSION BY PT ASST 47 47 258.07 $14018.47 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 15 15 13.16 $13.16 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 4.00 $2000.00 $500.00
SENS -V5264 EARMOLD 2 2 2.30 $43.06 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 12 13 66.66 $3332.87 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 833 962 5407.65 $367071.06 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.14 $170.72 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 49 50 319.71 $4220.23 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 12.86 $1285.71 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 934 1198 14786.41 $7393.22 $0.50
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Subtotal (Total Children Is Unduplicated) 1337 5672 36381.34 $1218125.75 $33.48
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Total 7161 37946.02 $1296982.57 $34.18
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Number of Children (Unduplicated) With at Least One Authorization 1354