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
EXIT -EXIT EXIT ASSESSMENT 19 19 3.994826 $199.7400 $50.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.511111 $25.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 20 21 5.017048 $250.0800 $49.8500
EI Services, Class # 03
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 15.336507 $766.8300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 24.714285 $1677.6100 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 28 33 6934.088892 $3467.0400 $0.5000
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Subtotal (Total Children Is Unduplicated) 81 162 7181.092072 $16211.9100 $2.2600
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Total 188 7189.863882 $16461.9900 $2.2900
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Number of Children (Unduplicated) With at Least One Authorization 101