Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 81 90 247.911113 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 81 90 247.911113 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 52 65 19.283333 $935.2400 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 5 6.683333 $401.0000 $60.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.022222 $1.6700 $74.9300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 22 22 0.216663 $16.2200 $74.8700
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 0.044444 $3.3300 $74.9300
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 0.166666 $8.0800 $48.4800
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.200000 $9.7000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.355555 $17.2400 $48.4900
SPCH -92506 SPEECH EVAL BY LICENSED SLP 3 3 0.222222 $10.7800 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.161111 $16.1100 $99.9900
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Subtotal (Total Children Is Unduplicated) 91 108 27.355549 $1419.3600 $51.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 25 13.583333 $20374.9500 $1500.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 159 194 1.472265 $73.8300 $50.1400
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 5 5 0.012501 $0.3200 $25.2000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 331 430 943.930182 $47196.6200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 109 149 297.494450 $14874.7500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 120 156 281.777781 $14088.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 337 439 865.556382 $43277.9800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 27 32 251.990475 $12599.5400 $50.0000
INTR -INTR INTERPRETER 39 55 571.731748 $28586.6000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 14 143.647618 $9750.8200 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 15 22 135.390474 $9190.3100 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.416667 $208.3500 $500.0400
SENS -V5264 EARMOLD 1 1 0.416667 $7.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 22 173.000000 $11743.2500 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 500 1349 477836.474608 $238918.2400 $0.5000
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Subtotal (Total Children Is Unduplicated) 512 2894 481516.895151 $450891.9400 $0.9400
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Total 3092 481792.161813 $452311.3100 $0.9400
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Number of Children (Unduplicated) With at Least One Authorization 593