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 26 29 37.396824 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 26 29 37.396824 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 6 1.077168 $52.2400 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 0.060274 $3.6200 $60.0300
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 74 75 23.338052 $1166.9000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 0.071762 $5.3900 $75.0400
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 0.033256 $2.4900 $74.8700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 0.093908 $5.2200 $55.5500
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 0.033180 $2.4900 $75.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.316667 $15.3600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 0.344444 $16.7000 $48.4900
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Subtotal (Total Children Is Unduplicated) 103 117 25.376245 $1270.7700 $50.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 11.172222 $55861.0000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 37 41 2.725844 $136.2800 $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 84 103 189.478931 $9473.9400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 15 22.604761 $1130.2300 $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
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 67.430920 $1685.7700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 43 53 338.473020 $16923.6400 $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 1 2 12.857142 $642.8600 $50.0000
INTR -INTR INTERPRETER 9 13 11.112536 $555.6300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 31.607143 $2145.5000 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 6 7 33.749999 $2290.9600 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 22 204.703971 $13895.2800 $67.8800
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Subtotal (Total Children Is Unduplicated) 218 541 1439.646444 $129953.4300 $90.2700
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Total 687 1502.419513 $131224.2100 $87.3400
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Number of Children (Unduplicated) With at Least One Authorization 292