Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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: 01/01/08 and 12/31/08 Date of Report: 02-16-09 Page: 1
Payor Filter: PARH PAHM DEI DEIM
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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 229 229 229.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 229 229 229.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 3.00 $145.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 3 3 3.00 $145.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 5 6 7.00 $339.50 $48.50
EI Services, Class # 03
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2 2 2.00 $100.00 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 4 4.00 $200.00 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 2.00 $100.00 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 3 3 30.00 $1500.00 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 14 14 126.43 $6321.43 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 2 2 14.57 $989.11 $67.88
PHY -97110 PT SESSION BY LICENSED PT 5 5 35.29 $2395.19 $67.88
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 87.07 $5910.09 $67.88
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Subtotal (Total Children Is Unduplicated) 27 39 301.35 $17515.81 $58.12
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Total 274 537.35 $17855.31 $33.23
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Number of Children (Unduplicated) With at Least One Authorization 233