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 2894 FSPSA's found of which 7 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 42 49 10.016669 $485.8000 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 11 12 15.493304 $774.6600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 80 81 38.413601 $1920.6700 $50.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.333333 $25.0000 $74.9900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 8 8 0.060575 $4.5500 $75.1500
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 0.041093 $2.2900 $55.6300
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.005479 $0.4100 $75.2900
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 2 0.249315 $12.7300 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.249315 $12.7300 $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 1 1 0.322222 $16.4500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.747945 $38.1800 $51.0500
SCREEN-T1023 SCREENING 4 6 1.383486 $69.1800 $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 1 1 0.249315 $12.7300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.024658 $1.2400 $50.0900
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Subtotal (Total Children Is Unduplicated) 141 184 69.209488 $3594.7900 $51.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 1.009210 $5046.5000 $5000.4500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.041096 $2.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 64 82 53.573658 $2678.6500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 4 17.269406 $431.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 249 580 1144.429655 $57221.3100 $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 15 16 620.857141 $15521.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 31 198.161902 $9908.1000 $50.0000
INTR -T1013 INTERPRETER 18 26 40.097164 $2004.8700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 416 803 4486.223464 $44862.2000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 10 84.571429 $6041.7800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 13 16 172.214286 $12302.9900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 25 213.071429 $15221.8300 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 66 90 354.006410 $177.0000 $0.5000
TRAV -TRAVS Travel by mile 429 1000 192782.428967 $85788.1900 $0.4500
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Subtotal (Total Children Is Unduplicated) 481 2709 200199.405216 $258408.6200 $1.2900
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Total 2894 200268.653593 $262003.4200 $1.3100
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Number of Children (Unduplicated) With at Least One Authorization 489