Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 40 43 58.142857 $2819.9300 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 9 9 9.000000 $450.0000 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 189 244 252.714286 $12256.6400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 204 248 262.428572 $12727.7900 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 142 158 177.000000 $8584.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 453 703 760.285715 $36883.8600 $48.5100
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 2 3 3.000000 $150.0000 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 13 13 16.338093 $816.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 12 14 7.522221 $376.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 10 9.988889 $499.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 12 12 13.265871 $663.2800 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 107 122 1229.428561 $30735.7900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 933 1255 10446.765049 $522338.6900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 318 408 2823.228589 $191640.8000 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 350 463 3067.357157 $208212.2300 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 22 25 24.533333 $24.5300 $1.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 25 30 95.898414 $4794.9200 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 274 327 2372.142864 $161021.1500 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.428571 $18.8600 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.285714 $28.5700 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 871 1388 9385.579346 $4692.7800 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 12 16 64.476191 $3223.8100 $50.0000
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Subtotal (Total Children Is Unduplicated) 1169 4088 29561.238863 $1129237.8400 $38.2000
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Total 4791 30321.524578 $1166121.7000 $38.4600
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Number of Children (Unduplicated) With at Least One Authorization 1176