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
Eligibility Filter: Program Patients
With the filters selected there were 4191 FSPSA's found of which 9 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 51 61 14.241630 $690.7100 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.005479 $0.1200 $22.0300
EVAL -96111 DEVELOPMENTAL EVALUATION 12 13 15.742619 $787.1300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 105 106 42.377378 $2118.8500 $50.0000
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 1 1 0.333333 $25.0000 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.010959 $0.6000 $55.1900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 36 36 0.246104 $18.5000 $75.1800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 0.035615 $2.6800 $75.1800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 47 47 0.247928 $13.8000 $55.6600
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 0.030135 $2.2700 $75.1600
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.011111 $50.5600 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 3 34.535029 $1763.0100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 0.457534 $23.3600 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 16 17 2.276712 $341.5100 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.322222 $16.4500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 1.736986 $88.6700 $51.0500
SCREEN-T1023 SCREENING 13 16 3.430593 $171.5300 $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 4 4 1.337519 $68.2800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 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) 237 336 118.907653 $6210.1000 $52.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 16 6.813472 $34068.0000 $5000.0900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.041096 $2.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 90 117 79.612454 $3980.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 17.851674 $446.2900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 329 788 1596.333642 $79816.4900 $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 16 16 13.200001 $660.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.233333 $55.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 22 24 691.571427 $17289.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 97 116 740.001581 $37000.0900 $50.0000
INTR -T1013 INTERPRETER 20 28 40.119310 $2005.9800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 549 1082 6064.254389 $60642.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 29 263.500001 $18824.4400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 32 38 391.642857 $27978.9800 $71.4400
SENS -V5264 EARMOLD 1 1 0.263014 $4.7300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 87 118 1052.123442 $75163.7200 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 93 138 479.766444 $239.8800 $0.5000
TRAV -TRAVS Travel by mile 571 1327 260615.541055 $115973.9300 $0.4500
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Subtotal (Total Children Is Unduplicated) 642 3854 272073.652525 $474775.2700 $1.7500
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Total 4191 272192.599067 $480985.3700 $1.7700
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Number of Children (Unduplicated) With at Least One Authorization 651