Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $3000.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 7 9 9.000000 $450.0000 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 336 420 462.890478 $23144.5300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 25 29.133334 $1456.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 30 34.133334 $1706.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 330 402 446.890478 $22344.5400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 27 218.428572 $10921.4400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 10 72.999999 $4955.2500 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 11 11 74.383334 $5049.1500 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 13 14 14.585714 $14.5900 $1.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 1.000000 $50.0000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 22 136.714286 $9280.1700 $67.8800
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Subtotal (Total Children Is Unduplicated) 416 974 1503.159529 $82438.0000 $54.8400
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Total 974 1503.159529 $82438.0000 $54.8400
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Number of Children (Unduplicated) With at Least One Authorization 416