Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 -92585 AUD EVOKED RESPONSE (DIAG) 3 3 3.000000 $155.2800 $51.7600
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 2.000000 $230.0000 $115.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 39 40 41.857143 $2030.0700 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 30 33 84.571429 $4101.7100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 82 91 89.096031 $4321.1500 $48.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 112 168 220.524603 $10838.2100 $49.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $1500.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 7 7 3.916666 $195.8300 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 48 92.396824 $4619.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 61 70 64.549204 $3227.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 705 821 542.386476 $27119.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 2.144445 $53.6100 $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 340 409 3597.715074 $179885.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 35 170.857147 $11597.7700 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 34 38 210.892862 $14315.4000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 0.928571 $50.4400 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 31 32 29.699999 $29.7000 $1.0000
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 3 4 33.790476 $1689.5200 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 145 172 1180.283340 $80117.6400 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 11.214286 $148.0300 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 954 1232 23943.353947 $11971.6700 $0.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1058 2882 29902.272174 $336961.5400 $11.2700
-------------------------------------------------------------------------------------------------------------------------------------
Total 3050 30122.796777 $347799.7600 $11.5500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1077