Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 51
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
Screening, Eval, and Assessment, Class # 02
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.000000 $48.5000 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 3 3.000000 $223.5000 $74.5000
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 2.857143 $142.8600 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 104 111 52.936114 $2646.8200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 0.475000 $11.8800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 51 51 289.249607 $14462.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.050000 $1.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 57 57 29.636906 $1481.8600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.050000 $1.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 114 116 57.510721 $2875.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.983334 $49.5900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 12.000000 $600.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 15 133.919048 $6695.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 43.047619 $2922.0600 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 8 8 50.095239 $3400.4600 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 1.000000 $500.0000 $500.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 21 21 164.142858 $11142.0200 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 187 279 39421.179356 $19710.5900 $0.5000
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Subtotal (Total Children Is Unduplicated) 204 675 40260.132945 $66644.6400 $1.6600
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Total 678 40263.132945 $66868.1400 $1.6600
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Number of Children (Unduplicated) With at Least One Authorization 205