Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 3595 FSPSA's found of which 1 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
Service Coordination, Class # 01
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 0.319054 $11.8100 $37.0100
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Subtotal (Total Children Is Unduplicated) 2 2 0.319054 $11.8100 $37.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 1.838281 $89.1600 $48.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 31 35 11.294442 $576.5700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 76 80 48.838092 $2493.1800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 48 51 15.299999 $781.0600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 64 66 108.533205 $5540.6300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.511111 $26.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 65 78 84.200788 $4298.4400 $51.0500
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Subtotal (Total Children Is Unduplicated) 213 317 270.515918 $13805.1200 $51.0300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 35 27.190474 $1359.5100 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 5 12 3.388887 $169.4400 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 9.571429 $239.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 127 163 1435.071421 $35876.8500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1060 1286 10655.866664 $532794.2700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1000 1263 10585.606889 $105856.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 141 175 1215.298411 $86821.0100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 11 78.214286 $4473.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 125 155 1104.588096 $78911.8400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 16 16 116.000002 $6630.5600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 122 151 922.500010 $65903.4100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 10.857143 $621.0300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 36.511112 $506.7700 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1 1 8.285714 $4.1400 $0.5000
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Subtotal (Total Children Is Unduplicated) 1283 3276 26208.950538 $920168.2100 $35.1100
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Total 3595 26479.785510 $933985.1300 $35.2700
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Number of Children (Unduplicated) With at Least One Authorization 1284