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 2 2 2.000000 $97.0000 $48.5000
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 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 9.000000 $675.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 7.000000 $525.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 13.500000 $749.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 79 91 174.500000 $9601.2500 $55.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 7.000000 $10500.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 2 2 2.000000 $100.0000 $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 55 59 83.604764 $4180.2500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 6 6.566667 $328.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 42 47 66.752382 $3337.6300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.933333 $73.3300 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 165.714286 $2071.4300 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 113.285713 $2832.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 41 51 408.633335 $20431.6700 $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 4 5 31.571429 $1578.5700 $50.0000
INTR -INTR INTERPRETER 11 14 16.000000 $800.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 18.071429 $1226.6900 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 1 1 1.000000 $67.8800 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 20 21 21.000000 $21.0000 $1.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 18 110.500001 $7500.7300 $67.8800
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Subtotal (Total Children Is Unduplicated) 168 330 1236.524534 $63979.9400 $51.7400
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Total 422 1412.024534 $73618.1900 $52.1400
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Number of Children (Unduplicated) With at Least One Authorization 217