Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 -V5010 ASSESSMENT FOR HEARING AID 11 11 20.000000 $900.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 12 12.000000 $1380.0000 $115.0000
EXIT -EXIT TRANSITION ASSESSMENT 11 11 22.000000 $1100.0000 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 3.000000 $145.5000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 4 4 4.000000 $194.0000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 4 4 4.000000 $194.0000 $48.5000
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Subtotal (Total Children Is Unduplicated) 34 45 65.000000 $3913.5000 $60.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 8.000000 $12000.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 56 77 143.042860 $7152.1500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 92 95 91.035714 $4551.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 24 25 18.321429 $458.0400 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 30 30 47.038100 $2351.9300 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 2 2 4.700000 $117.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 60 69 141.480958 $7074.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 2.833333 $70.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 49 91.135716 $4556.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 10.200000 $255.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 72 84 185.195245 $9259.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 13.833333 $345.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 70.571428 $1764.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 432 519 4077.565081 $203878.4100 $50.0000
INTR -INTR INTERPRETER 70 90 466.934525 $23346.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 161 201 1099.671435 $74645.6800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 6 6 30.928573 $1680.0400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 209 282 1521.314295 $103266.8800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 2 3 9.500000 $516.0400 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 84 97 97.000000 $97.0000 $1.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 12 12 12.000000 $6000.0000 $500.0000
SENS -V5264 EARMOLD 14 14 10.366667 $186.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 426 543 3214.881759 $218226.2200 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 20 23 283.999997 $3748.8000 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.000000 $100.0000 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 447 609 275961.047656 $137980.5200 $0.5000
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Subtotal (Total Children Is Unduplicated) 1060 2858 287613.598104 $823630.9300 $2.8600
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Total 2903 287678.598104 $827544.4300 $2.8800
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Number of Children (Unduplicated) With at Least One Authorization 1061