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
Eligibility Filter: Program Patients
With the filters selected there were 3115 FSPSA's found of which 409 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 29 35 26.628070 $1291.4600 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.304109 $14.2300 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 13 4.324888 $517.2700 $119.6000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 10 10 3.156469 $161.1400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 21 21 31.940965 $1630.5900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 26 12.046214 $614.9600 $51.0500
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Subtotal (Total Children Is Unduplicated) 86 107 78.400715 $4229.6600 $53.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 10 2.836911 $14185.5000 $5000.3300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 170 197 6.680789 $334.2100 $50.0300
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 4 0.013889 $0.3500 $25.0200
CONIF -CONIF CONSULT, FACE TO FACE 345 805 2564.238942 $128212.3700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 600 636 5500.626952 $275031.8200 $50.0000
INTR -T1013 INTERPRETER 15 15 32.683122 $1634.1600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 69 146 88.971433 $889.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 88 93 996.065768 $71159.0700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 88 95 947.652377 $67700.3600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 13.142857 $751.2500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 141 151 1427.607938 $101988.4700 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 424 838 1253.931764 $626.9700 $0.5000
TRAV -TRAVS Travel by mile 1 1 0.666667 $0.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 842 2992 12835.119409 $662514.5300 $51.6200
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Total 3099 12913.520124 $666744.1900 $51.6300
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Number of Children (Unduplicated) With at Least One Authorization 850