Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 04-01-13 and 06-30-13 Date of Report: 08-18-13 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 1 1 2.071429 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 2.071429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 5 6 0.346270 $20.7700 $59.9900
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.011111 $0.5000 $44.9600
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 0.138889 $15.9700 $115.0100
EXIT -EXIT EXIT ASSESSMENT 1 1 0.211111 $10.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 8 11 0.707381 $47.8000 $67.5700
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 0.714286 $35.7200 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 26 143 70.862498 $3543.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 7 4.900000 $245.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 6.661904 $333.1000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 2.044443 $102.2200 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.066667 $78.2100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.714286 $17.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 44 51 88.661904 $4433.1000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 0.150000 $7.5000 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 3.285714 $223.0300 $67.8800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 3.000000 $195.0000 $65.0000
SENS -V5264 EARMOLD 1 1 0.088889 $1.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 7.447619 $505.5400 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.714286 $22.6300 $13.2000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 46 141 9878.276191 $4939.1400 $0.5000
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Subtotal (Total Children Is Unduplicated) 53 367 10069.588687 $14682.7400 $1.4600
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Total 379 10072.367497 $14730.5400 $1.4600
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Number of Children (Unduplicated) With at Least One Authorization 54