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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 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
Service Coordination, Class # 01
SCONLY-SCONLY SERVICE COORDINATION ONLY 23 25 34.193652 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.005479 $0.2000 $37.1400
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Subtotal (Total Children Is Unduplicated) 24 26 34.199131 $0.2000 $0.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.763166 $37.0200 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 5 6 3.817961 $229.0800 $60.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.009589 $0.4800 $50.0600
EXIT -EXIT EXIT ASSESSMENT 54 55 47.961959 $2398.1000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.008333 $0.6200 $74.7000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 0.036034 $2.7000 $74.9300
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.016437 $1.2400 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 0.041360 $2.3000 $55.5500
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 86 86 7.157062 $536.7700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 28 28 6.155742 $461.6900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 42 42 9.267724 $514.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 55 56 3.903374 $292.7600 $75.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 5 5 1.055175 $51.1800 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 3 3 1.350000 $65.4800 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 182 302 82.071617 $4620.5600 $56.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 14.066667 $21100.0500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 2 2 1.472222 $73.6100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 16 0.130254 $6.5100 $49.9400
CONIF -CONIF CONSULT ITDS, FACE TO FACE 55 70 155.004771 $7750.2900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 52 65 130.440485 $6522.0700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 18.185716 $909.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 61 77 160.129377 $8006.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.971429 $74.2900 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 13 13 1665.285718 $20816.0700 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 326.428573 $8160.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 218 264 2099.766669 $104988.4500 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 6.133333 $306.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 3 3 7.933333 $396.6700 $50.0000
INTR -INTR INTERPRETER 15 19 7.302911 $365.1400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 80 95 652.415084 $44285.9400 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 8.714286 $473.3600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 55 64 519.847621 $35287.2900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 3 3 21.552381 $1170.7300 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 75 85 659.585716 $44772.7500 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 4 5 29.000000 $382.8000 $13.2000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 5 28.814286 $1440.7200 $50.0000
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Subtotal (Total Children Is Unduplicated) 349 809 6515.180832 $307289.9000 $47.1700
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Total 1137 6631.451580 $311910.6600 $47.0400
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Number of Children (Unduplicated) With at Least One Authorization 415