Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 43 47 33.313490 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 43 47 33.313490 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.213699 $2.0000 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.213699 $4.6400 $21.7300
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 0.449315 $20.2200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 14 8.702892 $1000.8200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 0.030137 $1.5100 $49.9400
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 25 27 9.650793 $468.0600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 53 54 27.343335 $1326.1400 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 13 14 13.265873 $643.3900 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 38 41 8.819328 $427.7300 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 114 125 38.703974 $1877.1100 $48.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 206 281 107.393045 $5771.6100 $53.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 2.258904 $3388.3500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 12 17 25.822234 $1291.1200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 10 6.428464 $321.4200 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 4 6 8.205481 $205.1400 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 48 57 31.261338 $1563.0600 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 64 74 153.894450 $3847.3800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 30 36.349553 $1817.4600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 19 30 44.499999 $1112.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 18 10.583332 $529.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 23 44.283335 $1107.0900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 34 39 28.264685 $1413.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 41 44 90.383337 $2259.5900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 95 115 991.242859 $49562.1900 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 7 11 69.279735 $3464.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 133 169 1170.324997 $79441.7100 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 12 13 55.071430 $2991.4800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 86 109 845.754760 $57409.8900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 17 25 109.000001 $5920.8800 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 1.578083 $789.0500 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 1.518722 $98.7200 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 0.701370 $159.9000 $227.9800
SENS -V5264 EARMOLD 8 11 9.542160 $171.7600 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 4 6 47.142858 $2357.1500 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 345 439 3234.462305 $219555.4400 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 7.000000 $380.2400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 40.714286 $537.4300 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 484 882 395275.068535 $197637.5300 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 2 3 13.230528 $661.5300 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 522 2157 402353.867741 $639994.3400 $1.5900
-------------------------------------------------------------------------------------------------------------------------------------
Total 2485 402494.574276 $645765.9500 $1.6000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 560