Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 04/01/10 and 06/30/10 Date of Report: 08-17-10 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 4 4 4.00 $0.00 $0.00
TCON -TCON TRANSITION CONFERENCE 3 3 3.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 6 7 7.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 4.00 $478.40 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 5 5 5.00 $250.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 61 61 121.00 $6050.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 6.50 $487.50 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 5.00 $375.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 3.50 $194.25 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 83 83 146.79 $11008.93 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 50 52 95.50 $7162.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 19.00 $1425.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 80 80 140.35 $7789.56 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 25 28 54.00 $4050.00 $75.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 11 11 11.00 $533.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 8 8 12.60 $611.33 $48.50
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.00 $100.00 $50.00
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Subtotal (Total Children Is Unduplicated) 214 356 628.24 $40639.46 $64.69
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 18 22.00 $33000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 6 6 6.00 $300.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 24 26.00 $1300.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 2 3.03 $75.84 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 30 34 28.25 $1412.50 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 3 4 6.25 $156.25 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 41 53 59.59 $2979.44 $50.00
CONOP -CONOP CONSULT, OT, PHONE 5 5 5.00 $125.00 $25.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.52 $37.92 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 30 35 35.72 $1785.84 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.64 $91.04 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 235.71 $2946.43 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 8 383.57 $9589.29 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 222 281 2018.36 $100918.10 $50.00
INTR -INTR INTERPRETER 14 24 32.00 $1600.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 92 112 762.40 $51751.72 $67.88
OCCT -97530HM OT SESSION BY OT ASST 10 10 40.39 $2194.01 $54.32
PHY -97110 PT SESSION BY LICENSED PT 65 79 619.10 $42024.19 $67.88
PHY -97110HM PT SESSION BY PT ASST 3 3 17.93 $973.88 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 17 18 30.00 $30.00 $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 2.80 $52.42 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 2.00 $100.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 119 146 1194.53 $81084.81 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 10 11 73.59 $971.39 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 4 5 33.50 $1675.00 $50.00
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Subtotal (Total Children Is Unduplicated) 413 889 5646.88 $339175.03 $60.06
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Total 1252 6282.12 $379814.50 $60.46
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Number of Children (Unduplicated) With at Least One Authorization 461