Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 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
SCONLY-SCONLY SERVICE COORDINATION ONLY 29 31 39.399207 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.005479 $0.2000 $37.1400
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Subtotal (Total Children Is Unduplicated) 30 32 39.404686 $0.2000 $0.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 2.274277 $110.3000 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 6 7 4.012482 $240.7500 $60.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.009589 $0.4800 $50.0600
EXIT -EXIT EXIT ASSESSMENT 74 76 63.756479 $3187.8300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.008333 $0.6200 $74.7000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 0.058103 $4.3600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 0.021916 $1.6500 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.027701 $2.0800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 0.046839 $2.6000 $55.5600
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 115 115 9.592328 $719.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 34 34 6.399956 $480.0100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 57 57 9.383777 $520.8000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 67 68 6.000289 $450.0200 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 4 4 2.690944 $130.5100 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 10 10 4.544063 $220.3800 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 6 6 2.961111 $143.6100 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 245 406 112.299298 $6240.9800 $55.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 12 29.136301 $43704.4500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 2.472222 $123.6100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 21 0.181605 $9.0700 $49.9400
CONIF -CONIF CONSULT ITDS, FACE TO FACE 88 114 238.404774 $11920.3000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 74 93 180.850008 $9042.5400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 10 26.452383 $1322.6300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 91 116 236.256364 $11812.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.971429 $74.2900 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 14 14 1731.000004 $21637.5000 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 12 12 542.142859 $13553.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 267 325 2588.995245 $129449.8800 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 6.133333 $306.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 5 5 31.219047 $1560.9600 $50.0000
INTR -INTR INTERPRETER 15 19 7.302911 $365.1400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 115 144 1022.534134 $69409.6100 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 8.714286 $473.3600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 89 106 844.680955 $57337.0000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 4 4 25.838095 $1403.5300 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 143 173 1416.971425 $96184.1400 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 6 7 45.714286 $603.4300 $13.2000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 6 7 32.480953 $1624.0500 $50.0000
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Subtotal (Total Children Is Unduplicated) 474 1189 9020.452619 $471918.6000 $52.3200
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Total 1627 9172.156603 $478159.7800 $52.1300
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Number of Children (Unduplicated) With at Least One Authorization 554