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 2372 FSPSA's found of which 161 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
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Subtotal (Total Children Is Unduplicated) 17 21 79.707939 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 17 19 9.030138 $437.9700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 3.772221 $177.6300 $47.0900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 0.757610 $19.3400 $25.5300
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 2 2 1.083333 $81.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.050000 $3.7500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.019179 $1.0700 $55.5700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.252055 $18.9100 $75.0100
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.252055 $18.9100 $75.0100
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 13 13 13.941531 $2091.2100 $150.0000
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) 86 99 92.530543 $6020.5200 $65.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 1.858980 $9295.0000 $5000.0500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 10.000000 $716.1000 $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
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 21 26 161.326982 $8066.3600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 544 1119 6065.736106 $60657.3900 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 13 17 117.633332 $8403.7400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 37 43 298.279545 $21309.1200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 8.285714 $115.0100 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 333 553 3762.441577 $1881.2200 $0.5000
TRAV -TRAVS Travel by mile 20 38 147.576189 $65.6700 $0.4400
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Subtotal (Total Children Is Unduplicated) 792 2252 11138.670939 $138786.1900 $12.4600
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Total 2372 11310.909421 $144806.7200 $12.8000
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Number of Children (Unduplicated) With at Least One Authorization 796