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 821 FSPSA's found of which 39 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
EXIT -EXIT EXIT ASSESSMENT 32 33 6.539045 $326.9600 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.411111 $30.8300 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.197260 $10.0700 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.605479 $30.9200 $51.0600
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Subtotal (Total Children Is Unduplicated) 35 38 7.752895 $398.7800 $51.4400
EI Services, Class # 03
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 4 4 41.000000 $1025.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 28 210.544441 $10527.2400 $50.0000
INTR -T1013 INTERPRETER 5 5 60.209524 $3010.4800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 150 218 1428.020628 $14280.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.571429 $326.5800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 3 23.285714 $1663.5400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 98.676190 $7049.4300 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 77 106 985.604428 $492.8000 $0.5000
TRAV -TRAVS Travel by mile 2 4 15.177560 $6.7500 $0.4400
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Subtotal (Total Children Is Unduplicated) 274 783 3337.192451 $61810.5300 $18.5200
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Total 821 3344.945346 $62209.3100 $18.6000
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Number of Children (Unduplicated) With at Least One Authorization 283