Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-11 and 12-31-11 Date of Report: 02-15-12 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 2.000000 $97.0000 $48.5000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 3.000000 $150.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 39 39 78.000000 $3900.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 3.500000 $262.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 7.000000 $525.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 5 7.500000 $416.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 51 51 88.000000 $6600.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 38 38 62.000000 $4650.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 2.500000 $187.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 24 24 39.000000 $2164.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 42 42 74.033333 $5552.5000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.000000 $48.5000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 4 4 4.000000 $194.0000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 5 5 6.000000 $291.0000 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 134 228 388.533333 $25813.7500 $66.4400
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 2 3 3.000000 $150.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 16 15.502740 $775.1400 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 2 6.571429 $164.2900 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 30 35 70.652381 $3532.6300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 37 52.721430 $2636.0800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.000000 $100.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 24 25 35.252381 $1762.6200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.683333 $67.0800 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 5 5 1235.000000 $15437.5000 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 25 870.857144 $21771.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 172 208 1693.280956 $84664.1200 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 13.142857 $657.1500 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 13.142857 $657.1500 $50.0000
INTR -INTR INTERPRETER 11 14 16.000000 $800.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 67 78 552.233336 $37485.6000 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 8 8 25.428570 $1381.2900 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 52 56 372.838094 $25308.2700 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 16 17 17.000000 $17.0000 $1.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 78 626.280953 $42511.9900 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 0.928571 $12.2600 $13.2000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 8 9 23.204762 $1160.2400 $50.0000
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Subtotal (Total Children Is Unduplicated) 303 624 5647.721794 $241051.8000 $42.6800
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Total 852 6036.255127 $266865.5400 $44.2100
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Number of Children (Unduplicated) With at Least One Authorization 341