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 -AUDE UNSPECIFIED AUDE SERVICES 1 1 0.333333 $20.0000 $59.9900
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 45 51 54.233788 $2711.6900 $50.0000
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
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.000000 $48.5000 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.046575 $2.3300 $50.0300
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Subtotal (Total Children Is Unduplicated) 56 63 62.808140 $3187.1200 $50.7400
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 21 21 23.306891 $1165.3400 $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 250 1131 1388.810862 $69440.3100 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 4 4 3.211111 $80.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 61 66 154.807944 $7740.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.466667 $86.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 59 68 167.168258 $8358.4100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.088889 $102.2200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 140 145 206.234921 $10311.7500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 7.704763 $192.6200 $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 31 34 251.787586 $12589.3900 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 2 1.033333 $51.6700 $50.0000
INTR -INTR INTERPRETER 11 13 106.714285 $5335.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 34.923809 $2370.6300 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 1 1 8.285714 $562.4300 $67.8800
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
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 14 109.933334 $7462.2600 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 606 1847 620118.993662 $310059.4700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 22.000000 $1100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 612 3405 622690.665823 $441828.1500 $0.7100
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Total 3495 622786.245393 $445015.2700 $0.7100
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Number of Children (Unduplicated) With at Least One Authorization 634