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 1466 FSPSA's found of which 261 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 14 17 12.129167 $588.2600 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.493151 $58.9900 $119.6100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.172602 $8.8100 $51.0500
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Subtotal (Total Children Is Unduplicated) 16 20 12.794920 $656.0600 $51.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.397260 $1986.5000 $5000.5000
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 75 81 310.398410 $15519.9400 $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 7 8 63.231746 $4517.2900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 4 33.138095 $2367.3900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 15 99.325396 $7095.8100 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 295 583 865.539693 $432.7700 $0.5000
TRAV -TRAVS Travel by mile 1 1 0.666667 $0.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 462 1445 3125.076104 $116505.8600 $37.2800
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Total 1465 3137.871024 $117161.9100 $37.3400
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Number of Children (Unduplicated) With at Least One Authorization 465