Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 114 131 138.00 $6693.00 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 1.01 $60.67 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.14 $53.56 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.00 $239.20 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 44 45 45.00 $2250.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 464 558 630.00 $30555.00 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 289 343 376.00 $18236.00 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 522 637 716.43 $34746.78 $48.50
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Subtotal (Total Children Is Unduplicated) 954 1722 1912.58 $92967.27 $48.61
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 24 25 25.17 $1258.33 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 23 26 17.23 $861.66 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 1.01 $25.28 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 12 7.14 $356.95 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 3.47 $173.33 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 17 10.47 $523.33 $50.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.00 $73.42 $73.42
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 131 176 1296.14 $32403.58 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1054 1419 10388.22 $519410.89 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 3 3 3.00 $150.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 624 817 5219.89 $354326.14 $67.88
OCCT -97530HM OT SESSION BY OT ASST 2 2 8.36 $453.96 $54.32
PHY -97110 PT SESSION BY LICENSED PT 476 636 4069.10 $276210.83 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 53 63 58.49 $58.49 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 4.00 $2000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 2.00 $130.00 $65.00
SENS -V5264 EARMOLD 2 2 2.31 $43.26 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 26 30 69.18 $3458.91 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 720 938 5533.75 $375630.64 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 15.00 $198.00 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 3 3 35.14 $3514.29 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1013 1576 9658.17 $4829.08 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 18 29 86.28 $4313.80 $50.00
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Subtotal (Total Children Is Unduplicated) 1475 5787 36516.51 $1583404.18 $43.36
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Total 7509 38429.10 $1676371.45 $43.62
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Number of Children (Unduplicated) With at Least One Authorization 1516