Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 24 27 23.488890 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 27 23.488890 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 37 14.122223 $684.9300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.238889 $10.2700 $42.9900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 4 1.349999 $80.9900 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 2.011110 $90.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 3.088889 $355.2200 $115.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 304 345 130.967445 $6351.8500 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 224 264 114.943645 $5574.7500 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.477778 $7.1700 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 141 169 64.365071 $3121.6700 $48.5000
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Subtotal (Total Children Is Unduplicated) 565 831 331.565049 $16277.3500 $49.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.511111 $766.6500 $1499.9700
AUD -HA_FUP AUDIOLOGY SERVICES 8 8 20.307144 $1015.3600 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3 3 4.838889 $241.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 44 54 43.403172 $2170.1500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 50 41.299997 $2064.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 31 36 25.884123 $1294.1900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 107 142 1176.714281 $29417.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1175 1603 13050.689650 $652535.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 384 469 3407.966661 $231333.0800 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 318 419 3131.894449 $212593.2400 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 1.100000 $550.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 2.500000 $162.5000 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 1.877778 $428.1400 $228.0000
SENS -V5264 EARMOLD 5 5 5.955555 $107.2000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 33 34 102.065086 $5103.2700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 224 292 1887.104764 $128096.7300 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.571429 $33.9400 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 22.428572 $2242.8500 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1171 1749 18269.258659 $9134.6100 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 12 17 116.407143 $5820.3600 $50.0000
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Subtotal (Total Children Is Unduplicated) 1486 4894 41314.778463 $1285112.3700 $31.1100
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Total 5752 41669.832402 $1301389.7200 $31.2300
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Number of Children (Unduplicated) With at Least One Authorization 1500