Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 13 15.03 $703.56 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 12 12.00 $1435.20 $119.60
EXIT -EXIT TRANSITION ASSESSMENT 2 2 3.00 $150.00 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 3.00 $145.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.00 $48.50 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 6.14 $614.29 $100.00
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Subtotal (Total Children Is Unduplicated) 20 32 40.18 $3097.05 $77.09
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 12 12.00 $18000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 55 74 134.48 $6724.23 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 27 24.25 $1212.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 4 4 1.50 $37.50 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 6 7 13.97 $698.34 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 7 7 4.06 $101.43 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 31 38 77.54 $3877.19 $50.00
CONOP -CONOP CONSULT, OT, PHONE 5 6 8.03 $200.66 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 29 49.85 $2492.38 $50.00
CONPP -CONPP CONSULT, PT, PHONE 4 4 2.96 $73.96 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 18 21 30.39 $1519.52 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 9 10 7.07 $176.64 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 69 102 1236.36 $30908.94 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 413 544 3935.05 $196752.60 $50.00
INTR -INTR INTERPRETER 44 55 213.29 $10664.29 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 199 274 1323.74 $89855.66 $67.88
OCCT -97530HM OT SESSION BY OT ASST 10 12 69.54 $3777.18 $54.32
PHY -97110 PT SESSION BY LICENSED PT 368 517 2672.91 $181437.29 $67.88
PHY -97110HM PT SESSION BY PT ASST 7 8 49.71 $2700.48 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 75 82 82.00 $82.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 12 12 12.00 $6000.00 $500.00
SENS -V5264 EARMOLD 12 12 7.13 $133.54 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 881 1214 7234.30 $491064.18 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 61 75 556.43 $7344.86 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 2 2.00 $200.00 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 42 49 774.00 $387.00 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 4 4 36.93 $1846.43 $50.00
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Subtotal (Total Children Is Unduplicated) 1392 3201 18571.48 $1058268.77 $56.98
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Total 3233 18611.66 $1061365.81 $57.03
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Number of Children (Unduplicated) With at Least One Authorization 1393