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 1657 FSPSA's found of which 58 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 3 4 4.700000 $173.9000 $37.0000
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Subtotal (Total Children Is Unduplicated) 3 4 4.700000 $173.9000 $37.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 60 64 14.518043 $725.9200 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 10.553968 $791.5500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.235616 $17.6700 $74.9900
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 5 5 0.358904 $18.3300 $51.0600
PSTH -97001 EVAL BY LICENSED PT, INITIAL 3 5 0.673973 $34.4100 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 0.920547 $47.0100 $51.0600
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Subtotal (Total Children Is Unduplicated) 72 88 35.496667 $2233.0500 $62.9100
EI Services, Class # 03
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 15 18 129.714285 $3242.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 211 280 2057.499585 $102875.1800 $50.0000
INTR -T1013 INTERPRETER 5 5 60.209524 $3010.4800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 239 355 2525.128386 $25251.3400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 14 113.369081 $8099.1000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 10 96.999999 $6929.6900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 44 59 419.373808 $29960.1100 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 138 183 1713.557544 $856.7800 $0.5000
TRAV -TRAVS Travel by mile 3 6 28.320417 $12.6000 $0.4400
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Subtotal (Total Children Is Unduplicated) 483 1565 7918.210887 $218863.4100 $27.6400
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Total 1657 7958.407554 $221270.3600 $27.8000
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Number of Children (Unduplicated) With at Least One Authorization 496