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: 10-01-15 and 12-31-15 Date of Report: 02-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3048 FSPSA's found of which 43 had no frequency modifier field, FORCE FREQ MODIFIER to 0
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 35 44 13.250021 $642.6300 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 9 9 4.043533 $202.1700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 63 64 62.212522 $3110.6600 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 0.082185 $6.1900 $75.2900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 0.016437 $1.2400 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 33 34 0.180809 $10.0700 $55.6700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 0.028766 $2.1600 $75.0900
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.100000 $5.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 4 53.262373 $2719.0500 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.120548 $6.1500 $51.0300
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 46 48 15.279583 $2291.9700 $150.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.106849 $5.4600 $51.0700
SCREEN-T1023 SCREENING 8 9 2.288052 $114.4200 $50.0100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.142466 $7.2700 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.795151 $193.7400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.065753 $3.3600 $51.0900
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Subtotal (Total Children Is Unduplicated) 175 246 154.980527 $9321.9300 $60.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 12.323516 $61618.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 59 63 39.809662 $1990.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 6.690356 $167.2600 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 191 490 849.871135 $42493.7100 $50.0000
CONIP -CONIP CONSULT, PHONE 1 2 6.133334 $153.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 17 433.285713 $10832.1600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 102 118 840.337137 $42016.9100 $50.0000
INTR -T1013 INTERPRETER 13 19 37.154108 $1857.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 410 716 5838.995484 $58389.9800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 24 273.357143 $19528.6500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 15 18 133.285714 $9521.9300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 76 769.714279 $54988.4800 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 248 385 2087.697116 $1043.8500 $0.5000
TRAV -TRAVS Travel by mile 396 862 162099.189303 $72134.1500 $0.4500
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Subtotal (Total Children Is Unduplicated) 574 2802 173427.844000 $376736.5500 $2.1700
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Total 3048 173582.824527 $386058.4800 $2.2200
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Number of Children (Unduplicated) With at Least One Authorization 583