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: 01-01-13 and 03-31-13 Date of Report: 05-17-13 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 18 21 20.530157 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 21 20.530157 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 5 0.732724 $35.5400 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 4 0.556240 $33.3700 $60.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 56 56 17.112937 $855.6400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 0.038812 $2.9100 $74.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.022069 $1.2300 $55.5700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 81 81 0.597890 $44.8500 $75.0100
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 0.120813 $9.0700 $75.0500
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 49 49 0.292989 $16.2800 $55.5700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 42 42 0.292686 $21.9500 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.153425 $7.4400 $48.4900
PSTH -97001 EVAL BY LICENSED PT, INITIAL 9 9 1.432191 $69.4700 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 0.344444 $16.7000 $48.4900
VISF -VISF VISION EVALUATION FUNCTIONAL 1 2 0.500000 $25.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 175 286 22.237934 $1142.3100 $51.3700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 7 13.782648 $68913.0000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 29 32 2.685850 $134.2800 $49.9900
CONIF -CONIF CONSULT ITDS, FACE TO FACE 60 92 176.049239 $8802.4700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 62 78 144.076192 $7203.8100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 10 16.704762 $835.2400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 67 89 174.919048 $8745.9600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 18.928571 $473.2200 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 17 18 1625.857141 $20323.2100 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 14 343.571429 $8589.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 227 298 2151.525405 $107576.1900 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 5.533333 $276.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 2 6.376190 $318.8100 $50.0000
INTR -INTR INTERPRETER 8 11 11.051424 $552.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 74 94 614.088091 $41684.2700 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.857143 $155.2000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 62 75 489.495235 $33226.9200 $67.8800
PHY -97110HM PT SESSION BY PT ASST 3 3 17.719047 $962.5000 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 86 109 805.623815 $54685.6700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 10.214286 $134.8300 $13.2000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 4 5 28.100000 $1405.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 362 946 6659.158849 $364999.0700 $54.8100
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Total 1253 6701.926940 $366141.3700 $54.6300
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Number of Children (Unduplicated) With at Least One Authorization 408