Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 12 12 4.816668 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 12 4.816668 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 1.066667 $64.0000 $60.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.155556 $132.8900 $115.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 4 4 0.900000 $43.6500 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 5 5 1.411111 $68.4400 $48.5000
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Subtotal (Total Children Is Unduplicated) 8 11 4.533334 $308.9800 $68.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.060274 $301.5000 $5002.1600
AUD -HA_FUP AUDIOLOGY SERVICES 5 5 28.015874 $1400.8000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 6 2.258448 $112.9300 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 24 24 11.028538 $551.4200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 24 24 41.333338 $1033.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 0.372603 $18.6300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 10.666667 $266.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 14 9.544443 $477.2200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 14 25.033337 $625.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 16 18 84.662699 $4233.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 12.833335 $320.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 38.571427 $1928.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 14 84.142857 $5711.6200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 2 2 4.642857 $252.2000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 6 6 45.071428 $3059.4500 $67.8800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 1.381888 $89.8300 $65.0100
SENS -V5264 EARMOLD 2 2 3.288889 $59.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 43 43 263.954767 $17917.2200 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 267 394 183248.460169 $91624.2300 $0.5000
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Subtotal (Total Children Is Unduplicated) 270 594 183915.323838 $129984.6500 $0.7100
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Total 617 183924.673840 $130293.6300 $0.7100
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Number of Children (Unduplicated) With at Least One Authorization 282