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 28 30 38.332540 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 28 30 38.332540 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.763166 $37.0200 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 2 2 0.276713 $16.6000 $60.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.009589 $0.4800 $50.0600
EXIT -EXIT EXIT ASSESSMENT 73 75 63.507164 $3175.3600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.011111 $0.8300 $74.9300
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 3.567845 $267.5900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 10 10 0.094290 $5.2300 $55.4400
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 3.565144 $267.3800 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.252055 $12.2300 $48.5100
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.511111 $24.7900 $48.5000
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Subtotal (Total Children Is Unduplicated) 99 115 72.569146 $3808.2200 $52.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 12.616666 $18924.9000 $1499.9900
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 2.472222 $123.6100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 20 0.178865 $8.9400 $49.9500
CONIF -CONIF CONSULT ITDS, FACE TO FACE 88 114 238.404774 $11920.3000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 73 92 177.783341 $8889.2100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 23.385716 $1169.3000 $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 1 1 328.571429 $4107.1400 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 42.857143 $1071.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 43 51 397.423814 $19871.2000 $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 4 4 25.085714 $1254.2900 $50.0000
INTR -INTR INTERPRETER 15 19 7.302911 $365.1400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 8 42.695238 $2898.1500 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 6 7 43.014285 $2919.8200 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 20 174.280952 $11830.2000 $67.8800
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Subtotal (Total Children Is Unduplicated) 203 474 1761.434196 $97547.4500 $55.3800
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Total 619 1872.335882 $101355.6700 $54.1300
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Number of Children (Unduplicated) With at Least One Authorization 289