Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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
Screening, Eval, and Assessment, Class # 02
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 0.633334 $30.7200 $48.5100
PSTH -97001 EVAL BY LICENSED PT, INITIAL 4 4 1.800001 $87.3100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 9 9 5.033335 $244.1300 $48.5000
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Subtotal (Total Children Is Unduplicated) 12 15 7.466670 $362.1500 $48.5000
EI Services, Class # 03
CONIF -CONIF CONSULT ITDS, FACE TO FACE 20 21 10.300002 $515.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 9 2.833334 $141.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 8 4.533333 $226.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 20 20 9.766668 $488.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 27 28 38.565478 $1928.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 11.192859 $759.7600 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 5 5 19.499999 $1323.6600 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 11 21.785713 $1478.8300 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 33 61 11148.285715 $5574.1400 $0.5000
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Subtotal (Total Children Is Unduplicated) 38 170 11266.763101 $12436.3700 $1.1000
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Total 185 11274.229771 $12798.5200 $1.1400
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Number of Children (Unduplicated) With at Least One Authorization 41