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 -V5090 DISPENSING FEE PER HEARING AID 1 1 0.010959 $1.2700 $115.4300
EXIT -EXIT EXIT ASSESSMENT 1 1 0.030137 $1.5100 $49.9400
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 0.672222 $32.6000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 12 13 3.283335 $159.2500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.350000 $16.9800 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 1.983333 $96.1900 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 22 24 10.723015 $520.0700 $48.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 43 50 17.053001 $827.8500 $48.5500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.702892 $1054.3500 $1500.0200
AUD -HA_FUP AUDIOLOGY SERVICES 6 8 13.729039 $686.4600 $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 47 55 29.728005 $1486.4000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 64 74 153.894450 $3847.3800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 29 34.916220 $1745.8000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 19 30 44.499999 $1112.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 16 9.049999 $452.5000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 23 44.283335 $1107.0900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 34 38 26.831352 $1341.5500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 41 44 90.383337 $2259.5900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18 24 178.609523 $8930.4800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 34 44 303.290477 $20587.3800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 4 5 21.714286 $1179.5200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 24 28 214.269045 $14544.6100 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 10.714286 $582.0000 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.493151 $246.6000 $500.0500
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 0.504110 $32.7700 $65.0000
SENS -V5264 EARMOLD 1 2 0.257534 $4.6400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 119 155 1108.249998 $75228.0700 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 483 880 394560.878059 $197280.4300 $0.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 496 1478 396861.633042 $334236.6500 $0.8400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1575 396911.999533 $335064.5000 $0.8400
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 533