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: 10-01-13 and 12-31-13 Date of Report: 02-18-14 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 5 5 3.754762 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5 5 3.754762 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 1.330288 $64.5100 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 4 0.819483 $49.1700 $60.0000
EXIT -EXIT EXIT ASSESSMENT 25 25 4.624963 $231.2500 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.511111 $38.3300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.511111 $28.3700 $55.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 4 4 1.045358 $50.7000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 3 3 0.788889 $38.2600 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 41 45 10.142314 $526.1500 $51.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 13.018722 $65094.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 2 6.428572 $321.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.944444 $23.6100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 54 59 97.409527 $4870.5000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 43 46 93.722225 $4686.1300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.944444 $23.6100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 16 33.000000 $1650.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 55 55 95.758732 $4787.9500 $50.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 10 10 1781.142859 $22264.2900 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 370.714287 $9267.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 169 173 1220.507144 $61025.4100 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 5.142857 $257.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 53 53 427.623809 $29027.1300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.642857 $89.2400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 62 62 448.747622 $30460.9900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 2 2 11.785714 $640.2000 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 78 621.649208 $42197.5800 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.428571 $71.6600 $13.2000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 38 45 10564.707941 $5282.3500 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 1 3.066667 $153.3400 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 288 622 15803.386202 $282194.4100 $17.8600
-------------------------------------------------------------------------------------------------------------------------------------
Total 672 15817.283278 $282720.5500 $17.8700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 301