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
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 0.355556 $21.3400 $60.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.866667 $99.6700 $115.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 0.966667 $46.8800 $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 1 1 0.511111 $24.7900 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.294444 $4.4200 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 9 9 26.999848 $1309.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 17 17 30.505404 $1531.3800 $50.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.155556 $233.4000 $1500.4200
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 1.233333 $61.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 12 105.780951 $5289.0500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 17.857143 $446.4300 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 187 213 1400.957159 $70047.9400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 3 3 8.361905 $209.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 47 341.080955 $17054.0500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.285714 $7.1400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 32 36 227.695241 $11384.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 5.800000 $145.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 71 75 523.304765 $26165.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.780952 $144.5300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 136 145 1215.690479 $60784.5700 $50.0000
INTR -INTR INTERPRETER 1 1 26.285714 $1314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 12.285714 $833.9500 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 4 4 63.571428 $4315.2300 $67.8800
PHY -97110HM PT SESSION BY PT ASST 2 2 15.000000 $814.8000 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 24 24 252.428570 $17134.8700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 60.000000 $792.0000 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 613 762 376948.923849 $188474.4600 $0.5000
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Subtotal (Total Children Is Unduplicated) 651 1344 381232.479428 $405652.4600 $1.0600
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Total 1415 382727.449912 $407183.8400 $1.0600
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Number of Children (Unduplicated) With at Least One Authorization 704