Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 114 125 331.911113 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 114 125 331.911113 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 77 99 32.988887 $1599.9500 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 50 53 20.322222 $1219.3300 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.405556 $18.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.588889 $182.7200 $115.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.027778 $2.0900 $75.0600
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.019444 $1.4600 $74.8300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 70 70 0.683322 $51.1700 $74.8800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 22 22 0.211108 $15.8100 $74.8900
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.188889 $9.1600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 34 34 8.794445 $426.5300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.588889 $28.5600 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 21 21 5.488888 $266.2100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 53 55 14.215081 $689.4400 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.161111 $16.1100 $99.9900
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Subtotal (Total Children Is Unduplicated) 308 368 85.684509 $4526.7900 $52.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 40 52 24.894442 $37341.3000 $1499.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 255 324 2.132008 $106.9200 $50.1500
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 9 9 0.023613 $0.6000 $25.2000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 479 625 1384.107968 $69205.5500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 193 273 560.159530 $28008.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 178 247 471.388890 $23569.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 516 682 1332.156391 $66608.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 482 623 4928.899197 $246445.2800 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 30 40 305.428571 $15271.4400 $50.0000
INTR -INTR INTERPRETER 42 60 620.998414 $31049.9300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 125 170 1472.282532 $99938.6700 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 104 144 1122.607932 $76202.6800 $67.8800
SENS -FM FM RECEIVER HEARING AID 1 2 0.511111 $843.3200 $1649.9600
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 1.427778 $713.9000 $500.0100
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 1.744444 $397.7200 $227.9900
SENS -V5264 EARMOLD 12 18 11.727777 $211.1000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 132 185 1578.892060 $107175.2700 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 779 2102 762129.807951 $381064.9000 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 39 59 345.900000 $17295.0200 $50.0000
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Subtotal (Total Children Is Unduplicated) 815 5621 776295.090609 $1201449.0500 $1.5500
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Total 6114 776712.686231 $1205975.8400 $1.5500
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Number of Children (Unduplicated) With at Least One Authorization 969