Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 324 FSPSA's found of which 33 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 5 5 3.025875 $151.3000 $50.0000
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Subtotal (Total Children Is Unduplicated) 5 5 3.025875 $151.3000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 28 40 1.102731 $55.1300 $49.9900
CONIF -CONIF CONSULT, FACE TO FACE 21 31 27.052266 $1352.5900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 31 31 209.442860 $10472.1600 $50.0000
INTR -T1013 INTERPRETER 29 30 1146.214288 $57310.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 18 153.400000 $10958.9100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 20 20 127.019049 $9074.2500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 39 45 320.823808 $22919.6700 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 82 103 548.019110 $274.0100 $0.5000
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Subtotal (Total Children Is Unduplicated) 183 318 2533.074112 $112417.4300 $44.3800
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Total 323 2536.099987 $112568.7300 $44.3900
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Number of Children (Unduplicated) With at Least One Authorization 187