Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 4 5.000000 $300.0000 $60.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.844444 $212.1100 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 13 14 21.000000 $2625.0000 $125.0000
EXIT -EXIT TRANSITION ASSESSMENT 84 96 201.000000 $10050.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 13.000000 $975.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 7.000000 $525.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 128 128 256.000000 $19200.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 22 44.000000 $3300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 79 80 160.000000 $12000.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 91 92 184.000000 $10212.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 117 118 236.000000 $17700.0000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 29 30 32.066667 $1555.2400 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 1.000000 $48.5000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 12 12 12.000000 $582.0000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 30 30 31.000000 $1503.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 358 648 1220.911111 $81871.3400 $67.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 26 27 35.000000 $52500.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 2 2 3.533333 $176.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 555 1506 4510.747535 $225536.9800 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 545 768 6367.952352 $318397.6600 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 2 2 6.857143 $171.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 184 241 1983.061893 $99153.1300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 17.428571 $435.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 270 379 3157.645219 $157882.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 55.714285 $1392.8600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 414 542 4518.642837 $225932.1600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.000000 $100.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 77 106 635.876196 $15896.9200 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 7.400001 $370.0100 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 0.800000 $20.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 533 720 5164.763509 $258238.3300 $50.0000
INTR -INTR INTERPRETER 19 25 169.285714 $8464.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 76 91 482.380954 $32744.0200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 10 12 57.473811 $3121.9800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 149 188 943.764292 $64062.7800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 3 4 18.928571 $1028.2000 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 62 68 171.714286 $171.7100 $1.0000
SENS -V5264 EARMOLD 1 1 0.844444 $15.2000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 0.357143 $17.8600 $49.9900
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 255 313 1726.828582 $117217.1600 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 5 6 21.142858 $279.0900 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 597 1467 1194384.195299 $597192.1000 $0.5000
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Subtotal (Total Children Is Unduplicated) 655 6482 1224446.338828 $2180518.5400 $1.7800
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Total 7130 1225667.249939 $2262389.8900 $1.8500
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Number of Children (Unduplicated) With at Least One Authorization 712