Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-13 and 03-31-13 Date of Report: 05-17-13 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 27 30 37.896824 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 30 37.896824 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 12 2.248858 $109.0700 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 5 5 0.616514 $36.9900 $60.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 76 77 23.682496 $1184.1200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 0.047145 $3.5300 $74.9300
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.024923 $1.8700 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.022069 $1.2300 $55.5700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 117 117 1.858956 $139.4300 $75.0100
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 37 37 1.210537 $90.8000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 72 72 0.461284 $25.6300 $55.5700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 52 52 0.356002 $26.7100 $75.0200
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.153425 $7.4400 $48.4900
PSTH -97001 EVAL BY LICENSED PT, INITIAL 15 15 5.048858 $244.8800 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 7 7 1.950000 $94.5800 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 2 0.500000 $25.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 250 411 38.205191 $1992.8800 $52.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 18 29.079223 $145396.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 40 46 2.740229 $136.9900 $49.9900
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.004167 $0.1100 $25.2000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 91 129 242.282573 $12114.1400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 0.033333 $0.8300 $24.9800
CONOF -CONOF CONSULT, OT, FACE TO FACE 85 104 190.545598 $9527.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 17 25.604761 $1280.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 131 246.947978 $12347.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 18.928571 $473.2200 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 19 20 1753.428570 $21917.8600 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 21 486.716635 $12167.9100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 276 361 2588.963504 $129448.0600 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 5.533333 $276.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 4 19.233332 $961.6700 $50.0000
INTR -INTR INTERPRETER 9 13 11.112536 $555.6300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 105 133 882.228571 $59885.6200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.857143 $155.2000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 94 118 779.992855 $52945.8900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 4 4 21.504761 $1168.1400 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 163 203 1693.275411 $114939.3800 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 14.500000 $191.4000 $13.2000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 6 31.100000 $1555.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 490 1340 9046.613084 $577444.6000 $63.8300
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Total 1781 9122.715099 $579437.4800 $63.5200
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Number of Children (Unduplicated) With at Least One Authorization 553