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 68 89 28.983333 $1405.6900 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 7 10 8.044444 $482.6600 $60.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.155556 $17.8900 $115.0300
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 1 1 0.008333 $0.6200 $74.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 48 48 0.461104 $34.5300 $74.8900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 0.133331 $9.9800 $74.8700
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 4 4 1.172221 $56.8500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.200000 $9.7000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.355555 $17.2400 $48.4900
SPCH -92506 SPEECH EVAL BY LICENSED SLP 7 7 3.726190 $180.7200 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.161111 $16.1100 $99.9900
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Subtotal (Total Children Is Unduplicated) 152 181 43.428956 $2234.0900 $51.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 38 17.833332 $26749.8000 $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 478 624 1383.474635 $69173.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 193 273 560.159530 $28008.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 174 240 458.055558 $22902.7900 $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 184 232 1873.701585 $93685.1900 $50.0000
INTR -INTR INTERPRETER 42 60 620.998414 $31049.9300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 24 31 254.219046 $17256.4200 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 28 40 280.838093 $19063.3000 $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 3 3 1.038889 $519.4500 $500.0100
SENS -V5264 EARMOLD 5 8 3.883333 $69.9000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 42 58 516.885712 $35086.2400 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 777 2093 760453.807951 $380226.9000 $0.5000
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Subtotal (Total Children Is Unduplicated) 793 4717 767759.719201 $791350.6500 $1.0300
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Total 5023 768135.059270 $793584.7400 $1.0300
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Number of Children (Unduplicated) With at Least One Authorization 921