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
Eligibility Filter: Program Patients
With the filters selected there were 2747 FSPSA's found of which 64 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 4 5 5.166667 $191.1700 $37.0000
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Subtotal (Total Children Is Unduplicated) 4 5 5.166667 $191.1700 $37.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 61 65 14.830372 $741.5300 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 10.756708 $806.7500 $75.0000
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 2 2 0.478082 $35.8600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 7.235616 $542.6700 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 42 43 9.815397 $501.1100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.194521 $9.9300 $51.0400
PSTH -97001 EVAL BY LICENSED PT, INITIAL 22 24 4.988584 $254.6800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 69 71 62.452555 $3188.2500 $51.0500
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Subtotal (Total Children Is Unduplicated) 168 213 111.954575 $6151.4800 $54.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 13 1.989042 $9946.0000 $5000.4000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 0.282192 $14.1100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 57 85 88.197435 $4409.8800 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 214 549 682.774156 $34138.7400 $50.0000
CONIP -CONIP CONSULT, PHONE 1 1 3.066667 $76.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 28 220.038096 $5500.9600 $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 487 644 4683.566245 $234178.6800 $50.0000
INTR -T1013 INTERPRETER 5 5 60.209524 $3010.4800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 239 356 2532.556957 $25325.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 81 107 752.814059 $53781.0700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 14.714285 $841.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 126 152 1080.919048 $77220.9200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 291 383 2807.030953 $200534.4700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 55.247618 $766.8400 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 139 184 1725.414687 $862.7100 $0.5000
TRAV -TRAVS Travel by mile 3 6 28.320417 $12.6000 $0.4400
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Subtotal (Total Children Is Unduplicated) 558 2529 14737.344121 $650631.5300 $44.1500
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Total 2747 14854.465363 $656974.1800 $44.2300
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Number of Children (Unduplicated) With at Least One Authorization 568