Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 3 3 7.238095 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 7.238095 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.022222 $17.1500 $16.7800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.022222 $25.0100 $24.4700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.511111 $23.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.511111 $58.7800 $115.0000
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Subtotal (Total Children Is Unduplicated) 1 4 3.066666 $123.9400 $40.4200
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 2 2 4.466667 $223.3400 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1695 2249 4387.169228 $219359.3600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1699 2201 4307.480339 $215374.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1694 2193 4187.258908 $209363.8300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1696 2247 4228.159373 $211408.8400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 273 350 2438.128575 $121906.5400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 26 198.892065 $13500.8000 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 13 17 160.179363 $10872.9900 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.511111 $255.5500 $499.9900
SENS -V5264 EARMOLD 1 1 1.022222 $18.4000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 10 11 30.953968 $1547.7000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 44 307.873018 $20898.4500 $67.8800
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Subtotal (Total Children Is Unduplicated) 1707 9342 20252.094837 $1024730.7000 $50.6000
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Total 9349 20262.399598 $1024854.6400 $50.5800
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Number of Children (Unduplicated) With at Least One Authorization 1707