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 26 23.422223 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 26 23.422223 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 32 12.883333 $624.8400 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 13 13 4.872222 $236.3000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 13 13 14.373015 $697.0900 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 8 8 2.672222 $129.6000 $48.5000
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Subtotal (Total Children Is Unduplicated) 53 66 34.800792 $1687.8300 $48.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.511111 $766.6500 $1499.9700
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 8.656349 $432.8200 $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 1 1 13.142857 $328.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 211 263 2069.297610 $103465.0300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 14 112.357142 $7626.8100 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 11 12 82.950794 $5630.7000 $67.8800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.888889 $57.7800 $65.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 9 9 30.757939 $1537.9000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 28.428571 $1929.7300 $67.8800
TRAN -TRAN FAMILY TRANSPORTATION 2 2 22.428572 $2242.8500 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1171 1747 18223.258659 $9111.6100 $0.5000
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Subtotal (Total Children Is Unduplicated) 1192 2203 20708.104674 $138901.7100 $6.7100
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Total 2295 20766.327689 $140589.5400 $6.7700
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Number of Children (Unduplicated) With at Least One Authorization 1226