Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 53 54 1464.465080 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 54 1464.465080 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 4.088888 $175.7800 $42.9900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 18 18 5.405329 $324.3200 $60.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 2.054110 $236.2300 $115.0100
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.427778 $20.7500 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 12 12 21.288574 $1032.5000 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.511111 $24.7900 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 7 7 4.948881 $240.0300 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.294444 $4.4200 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 42 42 64.474069 $3126.9900 $48.5000
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Subtotal (Total Children Is Unduplicated) 83 89 103.493184 $5185.8000 $50.1100
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.033333 $41.3300 $40.0000
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.358296 $537.4500 $1500.0200
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.357143 $93.4500 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 8 9 9.900000 $495.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 13 116.209522 $5810.4800 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 17.857143 $446.4300 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 192 219 1427.371445 $71368.6600 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 3 3 8.361905 $209.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 51 51 353.252383 $17662.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.285714 $7.1400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 42 246.119051 $12305.9600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 5.800000 $145.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 83 87 561.542862 $28077.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 18.923809 $473.1000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 7 109.714285 $2742.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 629 668 5584.492851 $279224.9500 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 6.571429 $328.5700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 9 9 21.114288 $1055.7300 $50.0000
INTR -INTR INTERPRETER 1 1 26.285714 $1314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 22 200.928572 $13639.0400 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 13.142857 $713.9200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 32 35 237.660316 $16132.3800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 6 6 48.000001 $2607.3600 $54.3200
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 1.788889 $407.8700 $228.0000
SENS -V5264 EARMOLD 6 7 13.222221 $238.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 96 102 977.384122 $66344.9200 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 18 18 195.000001 $2574.0000 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 615 769 379740.923849 $189870.4600 $0.5000
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Subtotal (Total Children Is Unduplicated) 752 2087 389944.602001 $714867.1600 $1.8300
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Total 2230 391512.560265 $720052.9700 $1.8400
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Number of Children (Unduplicated) With at Least One Authorization 806