Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 20 25 43.503969 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 25 43.503969 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 26 33 10.438889 $506.2900 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 4 4 1.611111 $78.1400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 5 7 1.488889 $72.2100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 4 4 1.016667 $49.3100 $48.5000
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Subtotal (Total Children Is Unduplicated) 38 48 14.555556 $705.9500 $48.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.494444 $2472.0000 $4999.5600
AUD -HA_FUP AUDIOLOGY SERVICES 5 5 9.214285 $460.7200 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2 2 2.928571 $146.4300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 39 52 28.295237 $1414.7600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 59 32.906346 $1645.3100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 19 22 21.617459 $1080.8700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 44 56 377.785713 $18889.2600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 55.428572 $3762.4800 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 9 11 67.280953 $4567.0200 $67.8800
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 0.700000 $45.5000 $65.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 4 4 3.201587 $160.0800 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 13.142857 $892.1400 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1008 1521 15324.103231 $7662.0700 $0.5000
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Subtotal (Total Children Is Unduplicated) 1017 1744 15937.099255 $43198.6400 $2.7100
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Total 1817 15995.158780 $43904.5800 $2.7400
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Number of Children (Unduplicated) With at Least One Authorization 1042