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
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 55 55 16.940715 $847.0300 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.288889 $14.0100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 0.344444 $16.7000 $48.4900
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Subtotal (Total Children Is Unduplicated) 63 66 18.325264 $914.4800 $49.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 4.733333 $23666.5000 $4999.9700
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 7 8 13.704762 $685.2400 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11 14 77.644446 $3882.2200 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 5.533333 $276.6700 $50.0000
INTR -INTR INTERPRETER 8 11 11.051424 $552.5700 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 2 3 10.428571 $707.8900 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 9 75.838096 $5147.8900 $67.8800
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Subtotal (Total Children Is Unduplicated) 142 343 715.592865 $60278.6900 $84.2400
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Total 430 754.448286 $61193.1700 $81.1100
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Number of Children (Unduplicated) With at Least One Authorization 193