Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 22 23 29.182541 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 23 29.182541 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 4.016667 $194.8100 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 0.333333 $20.0000 $59.9900
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 34 38 36.988126 $1849.4000 $50.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.046575 $2.3300 $50.0300
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Subtotal (Total Children Is Unduplicated) 42 46 42.384701 $2116.5400 $49.9400
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 21 21 23.306891 $1165.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 26 50.901589 $2545.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.005556 $0.1400 $25.2000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 199 873 1072.335873 $53616.6100 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 3 3 0.777778 $19.4500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 44 48 112.728578 $5636.4600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.000000 $75.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 57 145.930163 $7296.5100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.022222 $25.5600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 118 122 179.669049 $8983.4600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 4.360318 $109.0100 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.428571 $221.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8 8 59.419048 $2970.9600 $50.0000
INTR -INTR INTERPRETER 11 13 106.714285 $5335.7200 $50.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.066667 $1033.3500 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.504110 $32.7700 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 10.857143 $736.9800 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 480 1412 494402.506383 $247201.2300 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 22.000000 $1100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 485 2595 496202.534224 $338105.0400 $0.6800
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Total 2664 496274.101466 $340221.5700 $0.6900
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Number of Children (Unduplicated) With at Least One Authorization 505