Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 5.000000 $225.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 5.000000 $575.0000 $115.0000
EXIT -EXIT TRANSITION ASSESSMENT 8 8 16.000000 $800.0000 $50.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 2.000000 $97.0000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1 1 1.000000 $48.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 16 21 29.000000 $1745.5000 $60.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $1500.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 36 49 90.969841 $4548.4900 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 53 54 51.392857 $2569.6500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 11 11 8.250000 $206.2500 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 16 16 27.388098 $1369.4200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 2.533333 $63.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 37 86.523811 $4326.1900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.300000 $32.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 21 38.569049 $1928.4600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 7.200000 $180.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 38 44 99.754764 $4987.7500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 4.266666 $106.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 38.285714 $957.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 297 358 2770.041271 $138502.1700 $50.0000
INTR -INTR INTERPRETER 53 72 381.863097 $19093.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 82 102 502.742858 $34126.1700 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 4 4 17.071430 $927.3200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 131 168 907.961912 $61632.5000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 2.928571 $159.0800 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 64 74 74.000000 $74.0000 $1.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 5 5 5.000000 $2500.0000 $500.0000
SENS -V5264 EARMOLD 7 7 3.122223 $56.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 191 231 1323.485723 $89838.2200 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 11 14 127.857142 $1687.7100 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.000000 $100.0000 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 263 345 156683.761924 $78341.8800 $0.5000
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Subtotal (Total Children Is Unduplicated) 638 1625 163258.270284 $449814.2400 $2.7600
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Total 1646 163287.270284 $451559.7400 $2.7700
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Number of Children (Unduplicated) With at Least One Authorization 638