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: 10-01-13 and 12-31-13 Date of Report: 02-18-14 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 5 5 3.754762 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 3.754762 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.511111 $24.7900 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 3 3 0.575647 $34.5400 $60.0100
EXIT -EXIT EXIT ASSESSMENT 19 19 3.994826 $199.7400 $50.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.312329 $15.1500 $48.5100
SPCH -92506 SPEECH EVAL BY LICENSED SLP 3 3 0.788889 $38.2600 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 28 29 6.693913 $338.0300 $50.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 5.800000 $29000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 2 6.428572 $321.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.944444 $23.6100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 37 42 63.953972 $3197.7200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 29 31 61.055558 $3052.7900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.944444 $23.6100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 11.866666 $593.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 39 39 61.758732 $3087.9500 $50.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 10 10 1781.142859 $22264.2900 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 218.571430 $5464.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 137 141 1018.507143 $50925.4200 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 5.142857 $257.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 33 33 211.480955 $14355.3400 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 32 32 218.409527 $14825.6400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 2 2 11.785714 $640.2000 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 41 41 267.506347 $18158.3600 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 28 33 6934.088892 $3467.0400 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 1 3.066667 $153.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 209 424 10882.454779 $169811.4800 $15.6000
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Total 458 10892.903454 $170149.5200 $15.6200
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Number of Children (Unduplicated) With at Least One Authorization 220