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 2368 FSPSA's found of which 387 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 26 31 16.454586 $798.0500 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.158904 $7.4400 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.493151 $58.9900 $119.6100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 0.922222 $47.0800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.611111 $31.2000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 1.471688 $75.1300 $51.0500
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Subtotal (Total Children Is Unduplicated) 37 45 20.111662 $1017.8800 $50.6100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 1.160426 $5802.5000 $5000.3200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 169 196 6.672456 $333.8000 $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 211 226 1839.004748 $91950.3800 $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 22 25 271.968252 $19429.4400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 18 19 159.642857 $11404.9000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 45 48 479.008730 $34220.4200 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 424 833 1232.511129 $616.2600 $0.5000
TRAV -TRAVS Travel by mile 1 1 0.666667 $0.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 710 2322 6676.542651 $294494.5900 $44.1100
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Total 2367 6696.654313 $295512.4600 $44.1300
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Number of Children (Unduplicated) With at Least One Authorization 713