Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 16 17 13.922223 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 1.888889 $69.8900 $37.0000
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Subtotal (Total Children Is Unduplicated) 17 20 15.811112 $69.8900 $4.4200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 6.638888 $321.9800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.222222 $52.5400 $42.9900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 67 73 63.919630 $3835.1500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 11 8.866666 $399.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 24 26 26.041737 $2994.8100 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 3.000000 $375.0000 $125.0000
EXIT -EXIT EXIT ASSESSMENT 44 44 55.355869 $2767.7900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 4 3.389345 $254.2000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 28 28 42.873059 $3215.4800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 0.044444 $3.3300 $74.9300
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 36 36 46.351292 $2572.4900 $55.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 2.285714 $110.8600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 12 12 26.730953 $1296.4500 $48.5000
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Subtotal (Total Children Is Unduplicated) 163 252 286.719819 $18199.0700 $63.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 13 13.479745 $20219.4000 $1499.9800
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.144444 $78.8000 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.238889 $16.4500 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 21 22 120.422223 $6021.1200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 11 17 5.688892 $284.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 0.016667 $0.4200 $25.0500
CONIF -CONIF CONSULT ITDS, FACE TO FACE 141 646 1463.329440 $73166.8400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 4 4 4.372222 $109.3100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 57 58 144.777783 $7238.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 48 117.504767 $5875.2600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 6.733334 $168.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 87 93 205.645247 $10282.3000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 11.244445 $281.1100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 14 17 54.076190 $3964.8700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 27 120.457147 $3011.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 389 513 3412.690728 $170634.6600 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 12 14 39.549208 $1977.4700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 26.180951 $1777.1700 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 2 3 14.571428 $791.5200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 21 22 160.655576 $10905.3400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 16 17 119.428571 $6487.3700 $54.3200
SENS -FM FM RECEIVER HEARING AID 1 1 13.142857 $21685.7900 $1650.0100
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 2.511111 $1255.5500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 7.155556 $465.1100 $65.0000
SENS -V5264 EARMOLD 12 13 21.522222 $387.4000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 16 17 37.966668 $1898.3400 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 24 144.276189 $9793.4800 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 47.561905 $627.8200 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 415 1244 325718.639652 $162859.3200 $0.5000
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Subtotal (Total Children Is Unduplicated) 442 2851 332034.984057 $522265.3300 $1.5700
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Total 3123 332337.514988 $540534.2900 $1.6300
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Number of Children (Unduplicated) With at Least One Authorization 452