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: 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.84 $31.24 $37.00
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Subtotal (Total Children Is Unduplicated) 1 1 0.84 $31.24 $37.00
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 63 64 75.90 $4554.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 5.00 $234.00 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 29 29 30.89 $3694.31 $119.60
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 6 6 6.00 $750.00 $125.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 248 291 294.30 $14273.55 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 290 339 339.00 $16441.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 832 976 1064.93 $51649.04 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 11.00 $1100.00 $100.00
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Subtotal (Total Children Is Unduplicated) 1047 1711 1828.02 $92732.47 $50.73
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.00 $7500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 12 12 18.63 $931.67 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 399 426 643.41 $32170.39 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 70 72 104.03 $2600.73 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 32 117.32 $5865.85 $50.00
CONOP -CONOP CONSULT, OT, PHONE 3 3 2.53 $63.34 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 24 34.33 $1716.56 $50.00
CONPP -CONPP CONSULT, PT, PHONE 3 3 6.83 $170.85 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 758 904 991.03 $49551.70 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 78 81 87.73 $2193.15 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 60.00 $4405.20 $73.42
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 31 35 320.71 $8017.86 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 902 1107 9267.91 $463395.53 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 236 284 1603.64 $108855.32 $67.88
OCCT -97530HM OT SESSION BY OT ASST 46 47 270.00 $14666.41 $54.32
PHY -97110 PT SESSION BY LICENSED PT 269 310 1802.82 $122375.56 $67.88
PHY -97110HM PT SESSION BY PT ASST 37 37 225.98 $12275.03 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 19 19 13.99 $13.99 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 3 3 5.00 $2500.00 $500.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 1.00 $237.12 $237.12
SENS -V5264 EARMOLD 4 4 4.90 $91.73 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 15 15 83.16 $4158.02 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 902 1089 6275.04 $425949.59 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 35 36 175.86 $2321.31 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.71 $71.43 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 962 1306 12524.27 $6262.13 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 1 10.00 $500.00 $50.00
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Subtotal (Total Children Is Unduplicated) 1435 5862 34655.84 $1278860.47 $36.90
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Total 7574 36484.70 $1371624.18 $37.59
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Number of Children (Unduplicated) With at Least One Authorization 1455