Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2056 FSPSA's found of which 277 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 15 18 12.381222 $600.4900 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 2.982421 $356.7100 $119.6000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 5 5 1.423136 $72.6500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 13 13 4.166439 $212.7000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 13 9.007097 $459.8100 $51.0500
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Subtotal (Total Children Is Unduplicated) 46 57 29.960315 $1702.3600 $56.8200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 0.857078 $4286.0000 $5000.7100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 95 109 2.714900 $135.8400 $50.0300
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 0.012500 $0.3100 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 227 521 1643.068310 $82153.6900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 443 469 3864.772995 $193238.9900 $50.0000
INTR -T1013 INTERPRETER 13 13 30.754551 $1537.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 47 105 75.828576 $758.2900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 47 50 506.991169 $36219.5200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 56 61 612.671426 $43769.2800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 61 64 617.844438 $44138.8500 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 295 588 886.960328 $443.4800 $0.5000
TRAV -TRAVS Travel by mile 1 1 0.666667 $0.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 563 1989 8243.142938 $406682.2700 $49.3400
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Total 2046 8273.103253 $408384.6300 $49.3600
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Number of Children (Unduplicated) With at Least One Authorization 568