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 6 6 6.033333 $292.6200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.222222 $52.5400 $42.9900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 7 7 6.044444 $362.6600 $60.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.252055 $143.9900 $115.0000
EXIT -EXIT EXIT ASSESSMENT 44 44 55.355869 $2767.7900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.044444 $303.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 4.044444 $224.4600 $55.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 2.700000 $130.9500 $48.5000
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Subtotal (Total Children Is Unduplicated) 60 68 80.696811 $4278.3500 $53.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 3.629376 $5443.9500 $1499.9700
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 56 57 142.277783 $7113.9100 $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 6 6 9.044445 $226.1100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 3.266667 $239.5100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 6 43.133334 $1078.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 42 52 340.773015 $17038.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 1.142857 $57.1500 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 2 2 1.571428 $106.6700 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 6.571429 $356.9600 $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 2 2 4.177777 $75.2000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 2 2 4.533333 $226.6700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 1.285714 $87.2700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.142857 $15.0900 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 413 1235 323037.687271 $161518.8400 $0.5000
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Subtotal (Total Children Is Unduplicated) 423 2219 325546.759602 $312898.8100 $0.9600
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Total 2307 325643.267525 $317247.0500 $0.9700
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Number of Children (Unduplicated) With at Least One Authorization 432