Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1560 FSPSA's found of which 11 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
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.008219 $0.4100 $49.8800
EXIT -EXIT EXIT ASSESSMENT 3 3 0.988888 $49.4400 $50.0000
SCREEN-T1023 SCREENING 1 1 0.122222 $6.1100 $49.9900
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.057534 $2.9400 $51.0200
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Subtotal (Total Children Is Unduplicated) 6 6 1.176863 $58.9000 $50.0400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 3.033333 $151.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 64 82 47.469499 $2373.4800 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 290 804 1859.310244 $92965.7600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 12 78.264287 $3913.2100 $50.0000
INTR -T1013 INTERPRETER 7 10 50.576193 $2528.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 2 2.133334 $21.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 30.228571 $2159.5300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 16.428572 $1173.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 13.142857 $751.2500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 13 82.094047 $5864.8000 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 304 571 6185.064309 $3092.5200 $0.5000
TRAV -TRAVS Travel by mile 33 50 648.030158 $288.3700 $0.4400
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Subtotal (Total Children Is Unduplicated) 420 1554 9015.775404 $115284.3800 $12.7900
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Total 1560 9016.952267 $115343.2800 $12.7900
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Number of Children (Unduplicated) With at Least One Authorization 420