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
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Subtotal (Total Children Is Unduplicated) 5 5 3.754762 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 0.796499 $38.6300 $48.5000
EXIT -EXIT EXIT ASSESSMENT 23 23 4.427703 $221.3900 $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
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 26 29 6.757535 $352.2700 $52.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.652055 $3260.5000 $5000.3500
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
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 115.714286 $2892.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 27 27 156.765078 $7838.2500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 24.785714 $1682.4500 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 4 4 29.785714 $2021.8600 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 64.857143 $4402.5100 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 37 44 9776.136512 $4888.0700 $0.5000
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Subtotal (Total Children Is Unduplicated) 128 270 10496.904446 $43349.7000 $4.1300
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Total 304 10507.416743 $43701.9700 $4.1600
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Number of Children (Unduplicated) With at Least One Authorization 150