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: 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 18 19 21.805557 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 19 21.805557 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 37 14.196496 $688.5200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.253968 $56.7800 $45.2800
AUDE -AUDE UNSPECIFIED AUDE SERVICES 6 6 3.844444 $230.6600 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 9 3.722222 $167.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 6 3.566666 $410.1600 $115.0000
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 1 1 3.066667 $92.0000 $30.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.066667 $3.2400 $48.5200
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 351 454 153.961097 $7467.0500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.066667 $3.2400 $48.5200
PSTH -97001 EVAL BY LICENSED PT, INITIAL 249 326 138.460315 $6715.3200 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 160 193 69.497618 $3370.6300 $48.5000
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Subtotal (Total Children Is Unduplicated) 682 1036 391.702827 $19205.0900 $49.0300
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 12 17 55.450000 $2772.5000 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1 2 0.177778 $8.8900 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 29 37 24.199998 $1209.9900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 52 77 46.522217 $2326.0900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 15 18 18.194443 $909.7200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 115 156 1239.785703 $30994.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1261 1727 13588.014163 $679401.8800 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 3 0.905555 $45.2800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 422 568 4289.665046 $291182.8900 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 8 8 89.857143 $4881.0400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 303 432 2994.507138 $203267.4000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 11 11 127.142857 $6906.4100 $54.3200
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 3.061111 $198.9700 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 4 6 2.550000 $581.4000 $228.0000
SENS -V5264 EARMOLD 11 15 17.085713 $307.5400 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 25 36 91.571430 $4578.5700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 240 312 2072.221428 $140662.4700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 0.361111 $4.7700 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1230 1810 19863.337173 $198633.5200 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 11 11 106.285713 $53.1400 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 11 12 72.395237 $3619.7800 $50.0000
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Subtotal (Total Children Is Unduplicated) 1599 5264 44703.290957 $1572546.9500 $35.1800
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Total 6319 45116.799341 $1591752.0400 $35.2800
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Number of Children (Unduplicated) With at Least One Authorization 1609