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 28 35 11.133333 $539.9700 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 13 13 3.861111 $187.2600 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 10 13 3.155556 $153.0500 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 12 13 3.194444 $154.9300 $48.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 57 74 21.344444 $1035.2000 $48.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.494444 $2472.0000 $4999.5600
AUD -HA_FUP AUDIOLOGY SERVICES 5 5 9.214285 $460.7200 $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 1 1 1.285714 $32.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 218 281 1974.217470 $98710.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 17 112.695240 $7649.7400 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 11 14 83.995239 $5701.5900 $67.8800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 0.700000 $45.5000 $65.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 8 11 12.271428 $613.5700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 9 51.714287 $3510.3500 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1200 1819 18525.857216 $9262.9500 $0.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1217 2316 20870.726269 $133373.3000 $6.3900
-------------------------------------------------------------------------------------------------------------------------------------
Total 2418 20941.019127 $134408.5100 $6.4200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1246