Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 1797 FSPSA's found of which 13 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.142857 $5.2900 $37.0100
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 12 78.648810 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 13 78.791667 $5.2900 $0.0700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 4 119.433333 $5792.5200 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.266667 $2.7800 $10.4200
EXIT -EXIT EXIT ASSESSMENT 4 4 25.911111 $1295.5600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.544444 $40.8300 $74.9900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 15 2.238893 $167.9500 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.422222 $31.6700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 14 2.572226 $142.7800 $55.5100
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 6.066667 $309.7100 $51.0500
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Subtotal (Total Children Is Unduplicated) 25 42 157.455563 $7783.7800 $49.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.111111 $555.5000 $4999.5000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.505556 $25.2800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 78 80 36.915141 $1845.8000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.327778 $23.4700 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 56 64 240.149315 $12007.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 1.516667 $37.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 228 338 458.727782 $22936.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 27 34 47.699997 $1192.4900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.733333 $127.0900 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 20 52.100000 $2605.0100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 584 1077 5529.520756 $55295.2300 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.200000 $13.0000 $65.0000
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 71 116 666.972221 $333.4900 $0.5000
TRAV -TRAVS Travel by mile 2 2 1525.719842 $678.9500 $0.4500
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Subtotal (Total Children Is Unduplicated) 604 1742 8562.199499 $97677.1000 $11.4100
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Total 1797 8798.446729 $105466.1600 $11.9900
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Number of Children (Unduplicated) With at Least One Authorization 607