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
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 2 2 2.000000 $97.0000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 3 3 3.000000 $145.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 19 19 30.000000 $1488.0000 $49.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 8.000000 $12000.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 1 2 1.022222 $51.1100 $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 68 139.159529 $6957.9900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 2.833333 $70.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 48 90.735716 $4536.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 10.200000 $255.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 71 82 178.623817 $8931.2300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 13.833333 $345.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 13.142857 $328.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 149 173 1448.242856 $72412.2000 $50.0000
INTR -INTR INTERPRETER 70 90 466.934525 $23346.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 61 345.642857 $23462.2400 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 69 93 493.497619 $33498.6500 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 2.928571 $159.0800 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 84 97 97.000000 $97.0000 $1.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 190 244 1479.697622 $100441.8900 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 19.000000 $250.8000 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.000000 $100.0000 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 446 607 275373.904799 $137686.9500 $0.5000
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Subtotal (Total Children Is Unduplicated) 783 1744 280346.494899 $432412.1400 $1.5400
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Total 1763 280376.494899 $433900.1400 $1.5500
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Number of Children (Unduplicated) With at Least One Authorization 789