Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 17 17 35.955555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 17 35.955555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 26 29 7.361112 $357.0200 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 0.366667 $22.0000 $60.0100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.405556 $19.6700 $48.5100
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.333333 $16.1700 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1 1 0.211111 $10.2400 $48.5000
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Subtotal (Total Children Is Unduplicated) 29 33 8.677779 $425.1000 $48.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 1.538890 $7695.0000 $5000.3600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.183333 $9.1700 $49.9900
CONIF -CONIF CONSULT ITDS, FACE TO FACE 280 280 517.316674 $25865.8800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 99 99 185.355560 $9267.8000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 137 137 265.275396 $13263.7700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 279 279 475.469063 $23773.5300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 108 108 552.242853 $27612.1900 $50.0000
INTR -INTR INTERPRETER 17 17 217.334922 $10866.7500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 14 118.714286 $8058.3300 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 20 20 134.904761 $9157.3500 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.966667 $483.3500 $500.0200
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 0.366667 $83.6100 $228.0200
SENS -V5264 EARMOLD 4 4 3.066667 $55.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 23 210.714283 $14303.3100 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 482 929 290856.952385 $145428.4800 $0.5000
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Subtotal (Total Children Is Unduplicated) 486 1917 293540.402407 $295923.6900 $1.0100
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Total 1967 293585.035741 $296348.7900 $1.0100
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Number of Children (Unduplicated) With at Least One Authorization 503