Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 01/01/10 and 03/31/10 Date of Report: 05-17-10 Page: 1
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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 2.00 $97.00 $48.50
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.00 $300.00 $75.00
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.00 $150.00 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 41 41 76.36 $5726.78 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 17.50 $1312.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.50 $194.25 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 9.50 $712.50 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 68 91 91.00 $4413.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 48 51 51.00 $2473.50 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 81 108 108.00 $5238.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 58 61 69.71 $3381.14 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 173 232 232.00 $11252.00 $48.50
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Subtotal (Total Children Is Unduplicated) 319 605 666.57 $35251.18 $52.88
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 123 141 174.00 $8700.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 4 4 4.00 $100.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 247 325 511.72 $25586.10 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 113 149 271.03 $13551.55 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 104 136 264.60 $13230.03 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 222 280 414.54 $20727.14 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 4 4 1.80 $45.00 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 278 370 2610.35 $130517.42 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 0.33 $16.67 $50.00
INTR -INTR INTERPRETER 17 20 371.06 $18553.12 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 88 129 1057.00 $71749.08 $67.88
PHY -97110 PT SESSION BY LICENSED PT 117 161 1217.02 $82611.20 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 114 137 137.00 $137.00 $1.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 168 227 1538.57 $104438.23 $67.88
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 3 3 28.43 $1421.43 $50.00
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Subtotal (Total Children Is Unduplicated) 542 2089 8603.46 $494383.94 $57.46
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Total 2694 9270.03 $529635.12 $57.13
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Number of Children (Unduplicated) With at Least One Authorization 557