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: 01/01/08 and 12/31/08 Date of Report: 02-16-09 Page: 1
Payor Filter: PARH PAHM DEI DEIM
Child has a MEDICAID # Filter: Y
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 123 123 123.00 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.00 $37.00 $37.00
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Subtotal (Total Children Is Unduplicated) 124 124 124.00 $37.00 $0.30
Screening, Eval, and Assessment, Class # 02
EVAL -EVAL DEVELOPMENTAL EVALUATION 9 9 9.00 $450.00 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 1 1 4.00 $120.00 $30.00
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 1 1 3.00 $450.00 $150.00
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 2.00 $97.00 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 1 1 4.00 $200.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 16 16 24.00 $1515.50 $63.15
EI Services, Class # 03
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1 1 0.68 $34.17 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.93 $46.67 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 2.00 $100.00 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 1 1 10.00 $500.00 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 9 9 57.43 $2871.43 $50.00
INTR -INTR INTERPRETER 1 1 4.86 $242.86 $50.00
PHY -97110 PT SESSION BY LICENSED PT 1 1 11.57 $785.47 $67.88
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 20.43 $1386.69 $67.88
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 6 6 83.36 $41.68 $0.50
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Subtotal (Total Children Is Unduplicated) 18 22 191.26 $6008.95 $31.42
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Total 162 339.26 $7561.45 $22.29
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Number of Children (Unduplicated) With at Least One Authorization 148