Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-11 and 12-31-11 Date of Report: 02-15-12 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 22 22 25.000000 $1212.5000 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 1.000000 $60.0000 $60.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.0000 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 6.000000 $750.0000 $125.0000
EXIT -EXIT TRANSITION ASSESSMENT 137 139 273.750000 $13687.5000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 30.000000 $2250.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 28.000000 $1554.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 28 30 60.000000 $4500.0000 $75.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.000000 $48.5000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 4 4 4.000000 $194.0000 $48.5000
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Subtotal (Total Children Is Unduplicated) 204 243 455.750000 $26282.5000 $57.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 20.428571 $30642.9000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 12 12 19.033334 $951.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 116 132 205.045237 $10252.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 7 8 6.400000 $160.0000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 90 107 245.776192 $12288.8200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 26 30 60.152383 $1503.8100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 15 20 35.671430 $1783.5800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 63 71 144.376191 $7218.8200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 18 20 42.780954 $1069.5300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 86 105 256.980958 $12849.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 21 26 60.009524 $1500.2400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 16.142857 $403.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 11.714286 $585.7200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 23.523809 $1176.1900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 74 84 611.390482 $30569.5600 $50.0000
INTR -INTR INTERPRETER 94 160 760.383332 $38019.1800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 47.000000 $3190.3700 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 15 17 148.742857 $10096.6700 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 129 141 168.496825 $168.5000 $1.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.000000 $1000.0000 $500.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 20 176.428571 $11975.9700 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1521 2477 17418.965096 $8709.4800 $0.5000
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Subtotal (Total Children Is Unduplicated) 1630 3449 20484.509556 $186192.5600 $9.0900
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Total 3692 20940.259556 $212475.0600 $10.1500
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Number of Children (Unduplicated) With at Least One Authorization 1642