Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 42 45 60.142857 $2916.9300 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 2.044444 $122.6600 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 2.000000 $230.0000 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 9 9 9.000000 $450.0000 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 256 326 334.714286 $16233.6400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 245 300 314.428572 $15249.7900 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 204 231 274.857143 $13330.5700 $48.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 583 915 999.187302 $48623.6000 $48.6600
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 5 6 11.571429 $578.5700 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 17 17 21.320633 $1066.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 15 18 9.677776 $483.8800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 15 14.422222 $721.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 17 17 16.732538 $836.6200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 120 137 1358.857132 $33971.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1111 1483 12246.622189 $612331.6400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 396 505 3568.728586 $242245.3600 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 397 526 3537.714302 $240140.1000 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 29 35 34.533333 $34.5300 $1.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.000000 $1000.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 2.000000 $130.0000 $65.0000
SENS -V5264 EARMOLD 1 1 2.044444 $36.8000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 28 34 108.603177 $5430.1600 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 356 434 3115.928582 $211509.3200 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.428571 $18.8600 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.285714 $28.5700 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1058 1676 11189.855532 $5594.9200 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 14 18 77.804762 $3890.2400 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1410 4926 35320.130922 $1360048.1800 $38.5100
-------------------------------------------------------------------------------------------------------------------------------------
Total 5841 36319.318224 $1408671.7800 $38.7900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1417