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: 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
Service Coordination, Class # 01
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.000000 $37.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.000000 $37.0000 $37.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 3.000000 $145.5000 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 2.000000 $230.0000 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 3.000000 $150.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 57 57 114.000000 $5700.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 19.000000 $1425.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 3.500000 $262.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 9.000000 $675.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 9 15.500000 $860.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 65 65 112.500000 $8437.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 48 48 78.000000 $5850.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 2.500000 $187.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 33 33 54.000000 $2997.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 49 49 86.033333 $6452.5000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 3.000000 $145.5000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 8 8 8.000000 $388.0000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 9 9 10.000000 $485.0000 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 185 308 525.033333 $34491.2500 $65.6900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 11 15.000000 $22500.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 4 5 5.000000 $250.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 26 27.505480 $1375.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 2 6.571429 $164.2900 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 49 58 133.671429 $6683.5800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 56 60 84.604764 $4230.2500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 6 6.566667 $328.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 44 49 70.319049 $3515.9600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.933333 $73.3300 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 6 6 1400.714286 $17508.9300 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 31 997.000000 $24925.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 220 266 2150.319052 $107516.0300 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 2 2 14.142857 $707.1500 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 6 7 57.857143 $2892.8600 $50.0000
INTR -INTR INTERPRETER 11 14 16.000000 $800.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 91 105 762.514288 $51759.4900 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 9 9 29.857141 $1621.8500 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 87 101 690.085711 $46843.0600 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 1.000000 $54.3200 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 20 21 21.000000 $21.0000 $1.0000
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 120 147 1174.633332 $79734.2000 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 0.928571 $12.2600 $13.2000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 1.000000 $50.0000 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 10 11 37.347619 $1867.3900 $50.0000
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Subtotal (Total Children Is Unduplicated) 420 945 7708.572151 $375470.5300 $48.7100
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Total 1254 8234.605484 $409998.7800 $49.7900
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Number of Children (Unduplicated) With at Least One Authorization 472