Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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
Service Coordination, Class # 01
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.750000 $64.7500 $37.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.750000 $64.7500 $37.0000
Screening, Eval, and Assessment, Class # 02
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 2.000000 $250.0000 $125.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 1.000000 $48.5000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 10 10 10.000000 $485.0000 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 3.000000 $145.5000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 3 3 3.000000 $145.5000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 14 15 21.420636 $1038.9000 $48.5000
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Subtotal (Total Children Is Unduplicated) 28 33 40.420636 $2113.4000 $52.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 6.000000 $9000.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 4 4 8.844445 $442.2300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 9 6.922222 $346.1100 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 8 9 18.866668 $471.6700 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 41 46 38.892063 $1944.6000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 50 56 130.285720 $3257.1600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 19 15.600000 $780.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 19 20 40.700002 $1017.5100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 16 9.616668 $480.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 20 40.800001 $1020.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 33 39 38.186508 $1909.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 36 41 95.609528 $2390.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 24 29 245.814285 $12290.7300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 48 382.821431 $25985.9400 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 11.142857 $605.2800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 21 24 157.678572 $10703.2300 $67.8800
PHY -97110HM PT SESSION BY PT ASST 3 3 19.571429 $1063.1200 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 33 38 44.347620 $44.3500 $1.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 142 167 1164.928574 $79075.3900 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 26.142857 $345.0900 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 458 703 7726.975358 $3863.4800 $0.5000
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Subtotal (Total Children Is Unduplicated) 497 1301 10230.746808 $157101.2900 $15.3600
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Total 1335 10272.917444 $159279.4400 $15.5000
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Number of Children (Unduplicated) With at Least One Authorization 497