Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 1613 FSPSA's found of which 44 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 1 1 0.466667 $17.2700 $37.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.466667 $17.2700 $37.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 32 33 6.539045 $326.9600 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 0.613851 $46.0400 $74.9900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.202740 $15.2000 $74.9900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.242466 $18.1900 $75.0100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 32 33 8.697588 $444.0300 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 17 17 4.026940 $205.5800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 45 45 33.529855 $1711.7200 $51.0500
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Subtotal (Total Children Is Unduplicated) 107 132 53.852485 $2767.7200 $51.3900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 1.413699 $7069.5000 $5000.7100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 43 68 74.219656 $3710.9800 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 130 335 392.816214 $19640.8300 $50.0000
CONIP -CONIP CONSULT, PHONE 1 1 3.066667 $76.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 14 131.323811 $3283.1000 $25.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 0.202740 $10.1400 $49.9900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 300 390 2819.325387 $140966.4600 $50.0000
INTR -T1013 INTERPRETER 5 5 60.209524 $3010.4800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 150 219 1435.449199 $14354.5300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 40 52 341.230692 $24377.5200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 9.428571 $539.3200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 72 85 587.435714 $41966.4500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 147 188 1379.176190 $98528.4300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 16.000000 $222.0800 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 78 107 997.461571 $498.7300 $0.5000
TRAV -TRAVS Travel by mile 2 4 15.177560 $6.7500 $0.4400
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Subtotal (Total Children Is Unduplicated) 332 1480 8263.937195 $358261.9500 $43.3500
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Total 1613 8318.256347 $361046.9300 $43.4000
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Number of Children (Unduplicated) With at Least One Authorization 338