Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 24 27 16.977774 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 27 16.977774 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.111111 $5.3900 $48.5000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 12 12 21.165080 $1205.1500 $56.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.166666 $97.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 2.661111 $306.0300 $115.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 38 40 23.620635 $1145.6000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 36 41 12.272220 $595.1900 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 94 106 32.480955 $1575.3300 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 13.142857 $1314.2900 $100.0000
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Subtotal (Total Children Is Unduplicated) 143 206 107.620635 $6244.4800 $58.0200
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 1.066667 $53.3400 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1 1 0.261111 $13.0600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 64 68 90.715078 $4535.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.488889 $12.2200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 68 67.873806 $3393.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 734 847 1024.099180 $51204.8000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 4.394444 $109.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 12.571428 $314.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 332 393 3506.502384 $175325.2800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 19 123.142858 $8358.9400 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 34 41 317.964286 $21583.4400 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.511111 $255.5500 $499.9900
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 3 3.155555 $719.4500 $228.0000
SENS -V5264 EARMOLD 2 2 2.166666 $39.0000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 3 3 19.985715 $999.2900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 84 101 644.082541 $43720.3300 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 5.571429 $302.6400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 4 5 33.571429 $443.1400 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 914 1933 194978.588822 $97489.3000 $0.5000
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Subtotal (Total Children Is Unduplicated) 1003 3500 200836.713399 $408873.3100 $2.0400
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Total 3733 200961.311808 $415117.7900 $2.0700
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Number of Children (Unduplicated) With at Least One Authorization 1043