Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 46 47 1321.398413 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 46 47 1321.398413 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.294444 $4.4200 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1 1 0.416667 $20.2100 $48.5000
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Subtotal (Total Children Is Unduplicated) 2 2 0.711111 $24.6300 $34.6300
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 0.294444 $14.7200 $49.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 26.285715 $1314.2900 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 17.857143 $446.4300 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 103 117 788.280956 $39414.1100 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 2 2 4.933334 $123.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 18 18 119.038096 $5951.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 19 128.790478 $6439.5300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 5.800000 $145.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 30 31 226.995239 $11349.7700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 5.495238 $137.3800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 29.428572 $1471.4300 $50.0000
INTR -INTR INTERPRETER 1 1 26.285714 $1314.2900 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 13.142857 $892.1400 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 18.428572 $1250.9300 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 391 459 231406.123834 $115703.0600 $0.5000
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Subtotal (Total Children Is Unduplicated) 395 666 232817.180192 $185968.3100 $0.8000
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Total 715 234139.289716 $185992.9400 $0.7900
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Number of Children (Unduplicated) With at Least One Authorization 441