Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Statewide
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: 07-01-14 and 09-30-14 Date of Report: 11-19-14 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 3 3 2.511111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 2.511111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.088889 $4.3100 $48.5100
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 2 2 0.238889 $14.9600 $62.6300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.072222 $1.7700 $24.5400
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.022222 $117.5500 $115.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 9 9 1.394444 $67.6300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.172222 $8.3500 $48.4900
PSTH -97001 EVAL BY LICENSED PT, INITIAL 9 9 1.244445 $60.3600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 28 28 4.000004 $194.0200 $48.5000
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Subtotal (Total Children Is Unduplicated) 46 53 8.233337 $468.9600 $56.9600
EI Services, Class # 03
CONIF -CONIF CONSULT ITDS, FACE TO FACE 27 27 11.794446 $589.7300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 42 42 27.276192 $1363.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 31 31 14.750000 $737.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 137 138 63.680957 $3184.0700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 81 81 227.849206 $11392.4500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 12 26.390476 $1791.3800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.800000 $43.4600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 19 19 52.566665 $3568.2100 $67.8800
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 3 3 4.023810 $201.1900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 41 42 98.830951 $6708.6600 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 10.285714 $135.7700 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 343 505 1433.437303 $14334.3700 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 32 68 3167.380159 $1583.6900 $0.5000
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Subtotal (Total Children Is Unduplicated) 436 971 5139.065879 $45634.3000 $8.8800
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Total 1027 5149.810327 $46103.2600 $8.9500
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Number of Children (Unduplicated) With at Least One Authorization 447