Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 3469 FSPSA's found of which 234 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 17 21 79.707939 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.107143 $3.9600 $36.9900
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Subtotal (Total Children Is Unduplicated) 18 22 79.815082 $3.9600 $0.0500
Screening, Eval, and Assessment, Class # 02
AACIO -92597GO AAC INITIAL EVAL BY LICENSED OT 1 1 0.005479 $0.5600 $103.0300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 17 19 9.030138 $437.9700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 14 14 6.155554 $289.8600 $47.0900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.355556 $7.8100 $21.9500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.411111 $26.7800 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 1.009665 $25.7800 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 8 11.234126 $525.7600 $46.8000
EXIT -EXIT EXIT ASSESSMENT 39 45 63.034293 $3151.7200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.010959 $0.8300 $75.2800
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.283333 $15.7200 $55.4900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 5 3.649999 $273.7500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 4 0.727778 $54.5900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 0.693798 $38.5100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 2 0.756165 $56.7200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 2.038812 $113.1500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 2 0.756165 $56.7200 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.800000 $40.8400 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 14 14 13.941531 $2091.2100 $150.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 5 5 3.569559 $182.2300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.043836 $2.2400 $51.0100
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Subtotal (Total Children Is Unduplicated) 118 142 118.518815 $7393.5300 $62.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 23 6.209818 $31049.5000 $5000.0700
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 11.022222 $789.3000 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 42 24.362863 $1218.1500 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 303 395 488.402985 $24420.1300 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.833333 $45.8300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 8 10 52.766666 $2638.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 751 1002 6460.343995 $323017.5100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 544 1119 6065.736106 $60657.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 48.504763 $3465.1800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 30 38 252.885712 $18066.1800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 6.571429 $375.6200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 60 68 490.989069 $35076.2800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 17.571428 $243.8900 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 334 556 3780.727291 $1890.3600 $0.5000
TRAV -TRAVS Travel by mile 20 38 147.576189 $65.6700 $0.4400
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Subtotal (Total Children Is Unduplicated) 800 3305 17855.503869 $503019.3200 $28.1700
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Total 3469 18053.837766 $510416.8100 $28.2700
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Number of Children (Unduplicated) With at Least One Authorization 804