Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 23 28 48.948414 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 23 28 48.948414 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 43 19.372221 $939.5500 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 7 7 2.277777 $136.6600 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 1.305555 $58.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 2.588889 $297.7200 $115.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 328 404 143.146023 $6942.5400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 224 305 87.113487 $4224.9800 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 153 190 72.783340 $3530.0200 $48.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 609 961 328.587292 $16130.2200 $49.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.494444 $2472.0000 $4999.5600
AUD -HA_FUP AUDIOLOGY SERVICES 8 8 10.739682 $536.9900 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2 2 2.928571 $146.4300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 62 34.239681 $1711.9800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 65 37.106346 $1855.3100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 23 26 24.006348 $1200.3200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 91 134 950.080944 $23752.0300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1198 1630 12188.815899 $609440.0600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 408 537 3615.404770 $245413.3700 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 322 461 2910.209521 $197544.8500 $67.8800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 1.355555 $88.1100 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 5 5 1.355555 $309.0500 $227.9900
SENS -V5264 EARMOLD 6 6 2.855556 $51.4000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 25 36 86.325397 $4316.2700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 223 315 1827.518249 $124051.8900 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1200 1823 18542.857217 $9271.4500 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 9 14 66.647618 $3332.3800 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1486 5130 40302.941353 $1225493.8800 $30.4100
-------------------------------------------------------------------------------------------------------------------------------------
Total 6119 40680.477059 $1241624.1000 $30.5200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1497