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 27 30 11.107608 $538.7100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.111111 $5.0300 $45.2800
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 1.022222 $61.3300 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.511111 $23.0000 $45.0000
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 1 1 3.066667 $92.0000 $30.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 15 18 5.411110 $262.4300 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 11 12 3.955555 $191.8400 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 12 15 15.519842 $752.7200 $48.5000
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Subtotal (Total Children Is Unduplicated) 59 79 40.705226 $1927.0600 $47.3400
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 9 12 46.495239 $2324.7600 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 210 275 1998.031730 $99901.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 27 199.928570 $13571.1700 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 12 14 118.571427 $8048.6500 $67.8800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 4 2.038889 $132.5300 $65.0000
SENS -V5264 EARMOLD 1 2 0.511111 $9.2000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 6 7 11.738096 $586.9100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 13 66.571429 $4518.8700 $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 1807 19844.194316 $198442.0900 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 11 11 106.285713 $53.1400 $0.5000
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Subtotal (Total Children Is Unduplicated) 1263 2307 22483.822067 $332048.4800 $14.7700
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Total 2405 22546.332850 $333975.5400 $14.8100
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Number of Children (Unduplicated) With at Least One Authorization 1290