Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 4 4 4.000000 $194.0000 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 62 63 63.000000 $3780.0000 $60.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 6.000000 $690.0000 $115.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 84 84 150.500000 $8352.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 8.500000 $637.5000 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 47 51 52.000000 $2522.0000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 38 39 38.100000 $1847.8500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 43 47 47.000000 $2279.5000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 42 43 43.000000 $2085.5000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 145 150 150.000000 $7275.0000 $48.5000
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Subtotal (Total Children Is Unduplicated) 388 492 564.100000 $29775.1000 $52.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 27 56.000000 $84000.0000 $1500.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 222 268 248.642857 $12432.1500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 1.750000 $43.7500 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 438 540 1299.350815 $64967.6400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 185 238 525.541285 $26277.1400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 187 260 546.277787 $27313.9400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 476 601 1243.784158 $62189.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 447 549 4661.898413 $233095.0800 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 5 5 33.904761 $1695.2400 $50.0000
INTR -INTR INTERPRETER 35 64 689.369839 $34468.5000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 104 142 1164.414288 $79040.4700 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 105 148 1159.996821 $78740.6200 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 112 124 124.000000 $124.0000 $1.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.000000 $1000.0000 $500.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 3.000000 $684.0000 $228.0000
SENS -V5264 EARMOLD 4 4 7.000000 $126.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 195 252 2201.564281 $149442.2800 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.142857 $713.9200 $54.3200
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 363 562 279405.714293 $139702.8600 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 11 11 95.142858 $4757.1400 $50.0000
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Subtotal (Total Children Is Unduplicated) 872 3802 293482.495313 $1000814.0900 $3.4100
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Total 4294 294046.595313 $1030589.1900 $3.5000
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Number of Children (Unduplicated) With at Least One Authorization 921