Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 1561 FSPSA's found of which 46 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 3 3.000000 $111.0000 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 10 45.040476 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 13 48.040476 $111.0000 $2.3100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 64.000000 $3104.0000 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 4 10.000000 $500.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 9 9 8.488028 $424.4100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 2.033333 $152.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 5.066667 $380.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 8 3.649999 $273.7400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 1.522222 $84.4800 $55.5000
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 2 2 1.433334 $215.0100 $150.0100
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 4.866667 $248.4500 $51.0500
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Subtotal (Total Children Is Unduplicated) 28 34 101.060250 $5382.5800 $53.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.261111 $1305.5000 $4999.7900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 43 44 15.284299 $764.2100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.444444 $31.8200 $71.6000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 38 50 139.639137 $6981.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.266667 $6.6700 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 157 218 304.901585 $15245.0700 $50.0000
CONIP -CONIP CONSULT, PHONE 15 19 18.344445 $458.6100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 3.511111 $257.4300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 2.571429 $64.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 19 21 207.607143 $10380.3600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 439 766 4093.753924 $40937.5600 $10.0000
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 239 383 2964.062056 $1482.0300 $0.5000
TRAV -TRAVS Travel by mile 6 7 3148.442857 $1401.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 583 1514 10899.090208 $79316.5500 $7.2800
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Total 1561 11048.190934 $84810.1300 $7.6800
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Number of Children (Unduplicated) With at Least One Authorization 586