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: 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
AUDE -AUDE UNSPECIFIED AUDE SERVICES 3 3 3.000000 $180.0000 $60.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 24.500000 $1359.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 12 13 14.000000 $679.0000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.000000 $48.5000 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 4 4 4.000000 $194.0000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 7 7 7.000000 $339.5000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 21 21 21.000000 $1018.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 58 65 78.500000 $4066.2500 $51.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 7 21.000000 $31500.0000 $1500.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 140 168 164.142857 $8207.1500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.500000 $12.5000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 292 366 857.006364 $42850.3800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 108 135 292.276194 $14613.8300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 124 169 347.647625 $17382.4100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 305 387 759.601607 $37980.1700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 34 37 276.571431 $13828.5800 $50.0000
INTR -INTR INTERPRETER 34 63 684.836506 $34241.8300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 22 178.561906 $12120.7800 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 14 19 125.658729 $8529.7300 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 73 83 83.000000 $83.0000 $1.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 32 248.576190 $16873.3700 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 223 333 171589.523813 $85794.7600 $0.5000
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Subtotal (Total Children Is Unduplicated) 510 1822 175628.903222 $324018.4800 $1.8400
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Total 1887 175707.403222 $328084.7300 $1.8700
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Number of Children (Unduplicated) With at Least One Authorization 517