Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 4193 FSPSA's found of which 14 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 1 1 0.038889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.038889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 50 60 12.596197 $610.9100 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 9 3.253881 $71.4200 $21.9500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.011111 $47.3200 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 14.011111 $1675.7300 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 12 13 15.783715 $789.1800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 80 81 38.413601 $1920.6700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 0.027395 $2.0600 $75.2900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.511111 $38.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 0.043985 $2.4500 $55.6400
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 113 113 0.728503 $54.7600 $75.1600
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 13 13 0.208214 $15.6400 $75.1000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 135 135 2.251857 $125.0800 $55.5500
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 0.071228 $5.3600 $75.1800
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 8 11 2.750925 $140.4400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 20 22 24.842542 $1268.2100 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 9 9 1.369863 $205.4700 $149.9900
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 9 11 2.492925 $127.2700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 27 30 19.869863 $1014.3600 $51.0500
SCREEN-T1023 SCREENING 8 10 3.143913 $157.2000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.249315 $12.7300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 29 31 18.562327 $947.6000 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 4 4 0.279452 $13.9800 $50.0100
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Subtotal (Total Children Is Unduplicated) 315 585 162.478513 $9246.5600 $56.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 54 67 15.702135 $78512.0000 $5000.0800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.041096 $2.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 64 83 53.822973 $2691.1100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 4 17.269406 $431.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 249 583 1149.196322 $57459.6400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 6 12.666666 $316.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 6.116667 $305.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 12 12 10.433333 $521.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.233333 $55.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 38 45 1670.142853 $41753.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 352 454 3539.657129 $176982.8300 $50.0000
INTR -T1013 INTERPRETER 18 26 40.097164 $2004.8700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 416 804 4492.152035 $44921.4900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 81 110 996.676192 $71202.5400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 26.000000 $1487.2000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 114 158 1331.000615 $95086.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.156164 $8.9300 $57.1700
SENS -V5264 EARMOLD 1 1 0.723288 $13.0200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 118 153 1343.227002 $95960.1600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.285714 $245.1400 $57.2000
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 68 92 356.673077 $178.3400 $0.5000
TRAV -TRAVS Travel by mile 429 1001 193138.143253 $85946.4800 $0.4500
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Subtotal (Total Children Is Unduplicated) 512 3607 208206.416417 $756087.8000 $3.6300
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Total 4193 208368.933819 $765334.3600 $3.6700
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Number of Children (Unduplicated) With at Least One Authorization 512