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
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Subtotal (Total Children Is Unduplicated) 23 25 34.193652 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.763166 $37.0200 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 0.082192 $4.9300 $60.0100
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.009589 $0.4800 $50.0600
EXIT -EXIT EXIT ASSESSMENT 53 54 47.712644 $2385.6400 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 1.523554 $114.2600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 0.022222 $1.2300 $55.4400
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 1.509589 $113.2200 $75.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.511111 $24.7900 $48.5000
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Subtotal (Total Children Is Unduplicated) 63 69 52.134067 $2681.5700 $51.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 4.866667 $7300.0500 $1500.0100
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 6 6 15.119049 $755.9600 $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 1 1 328.571429 $4107.1400 $12.5000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10 11 88.571428 $4428.5800 $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 2 2 1.800000 $90.0000 $50.0000
INTR -INTR INTERPRETER 15 19 7.302911 $365.1400 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 2 2 15.942857 $1082.2000 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 7 39.995239 $2714.8800 $67.8800
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Subtotal (Total Children Is Unduplicated) 132 283 958.451451 $43583.9000 $45.4700
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Total 377 1044.779170 $46265.4600 $44.2800
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Number of Children (Unduplicated) With at Least One Authorization 195