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 -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 47 51 97.000000 $5069.0000 $52.2600
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 1.000000 $50.0000 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7 8 63.857144 $3192.8600 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 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 1 1 13.142857 $892.1400 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 16 17 17.000000 $17.0000 $1.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 34.857143 $2366.1000 $67.8800
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Subtotal (Total Children Is Unduplicated) 104 166 344.383695 $17013.0600 $49.4000
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Total 217 441.383695 $22082.0600 $50.0300
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Number of Children (Unduplicated) With at Least One Authorization 129