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
Eligibility Filter: Program Patients
With the filters selected there were 1941 FSPSA's found
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 1 1 0.219052 $8.1100 $37.0100
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Subtotal (Total Children Is Unduplicated) 1 1 0.219052 $8.1100 $37.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 2.054947 $99.6600 $48.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 6 1.144444 $58.4200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 16 17 10.000001 $510.5100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 5 7 1.494444 $76.2900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 8 8 6.922221 $353.3700 $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 13 14 20.630158 $1053.1700 $51.0500
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Subtotal (Total Children Is Unduplicated) 42 59 42.757326 $2177.5200 $50.9300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 33 27.246030 $1362.2900 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 6 11 3.349999 $167.5000 $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 2 2 9.857142 $246.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 236 277 2333.383026 $116669.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1186 1497 12520.783860 $125208.0400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 20 127.999999 $9144.3300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 15.714286 $898.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 14 16 100.642857 $7189.9200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 4.714286 $269.4700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 20 151.428570 $10818.0700 $71.4400
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) 1228 1881 15312.977198 $272217.6600 $17.7800
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Total 1941 15355.953576 $274403.2800 $17.8700
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Number of Children (Unduplicated) With at Least One Authorization 1235