Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 26 27 32.771430 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 26 27 32.771430 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 4.150000 $201.2800 $48.5000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 3 3 0.705556 $40.1800 $56.9400
AUDE -AUDE UNSPECIFIED AUDE SERVICES 32 33 26.950605 $1617.0100 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 1.288888 $58.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.866667 $329.6700 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 49 59 67.303629 $3365.1800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 5.129137 $384.6800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.022222 $76.6700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.022222 $76.6700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 2.366438 $131.3400 $55.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 2 0.577778 $28.0200 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 13 13 10.935389 $530.3700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.683333 $33.1400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 10 10 4.652130 $225.6300 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 28 28 73.072222 $3544.0100 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 0.224353 $11.2200 $50.0100
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Subtotal (Total Children Is Unduplicated) 139 174 203.950569 $10703.0500 $52.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.005555 $1508.2500 $1499.9200
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.433333 $29.8400 $68.8500
AUD -HA_FUP AUDIOLOGY SERVICES 24 24 25.184668 $1259.2200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 38 70.046033 $3502.3100 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 1.148413 $28.7100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 257 1170 1474.905315 $73745.0700 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 4 4 3.211111 $80.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 66 72 165.324610 $8266.2700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.466667 $86.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 71 179.873021 $8993.6500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.088889 $102.2200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 149 156 228.590478 $11429.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 7.704763 $192.6200 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 4.866667 $121.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 2.066667 $51.6700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.428571 $221.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 476 533 4734.487601 $236724.6000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 23 26 112.244450 $5612.2200 $50.0000
INTR -INTR INTERPRETER 11 13 106.714285 $5335.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 55 519.495235 $35263.3700 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 2 2 24.714286 $1342.4800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 68 75 699.514281 $47483.0800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 4 4 63.428571 $3445.4500 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.066667 $1033.3500 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.504110 $32.7700 $65.0000
SENS -V5264 EARMOLD 12 12 19.533329 $351.5900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 105 111 984.088889 $66800.0100 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 11.285714 $613.0400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 26.285714 $346.9700 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 623 1903 646012.779379 $323006.3700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 4 5 33.785715 $1689.2900 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 6 7 59.000001 $2950.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 632 4303 655586.272988 $841649.6700 $1.2800
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Total 4504 655822.994987 $852352.7200 $1.3000
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Number of Children (Unduplicated) With at Least One Authorization 654