Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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 7184 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.928571 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 84 93 203.778565 $7539.7900 $37.0000
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Subtotal (Total Children Is Unduplicated) 84 94 204.707136 $7539.7900 $36.8300
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 2.000000 $205.2600 $102.6300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 18 17.357491 $841.8300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 0.411111 $19.3600 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 91.000000 $1358.6300 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 104.965079 $2015.3300 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 91.000000 $948.2200 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 91.000000 $1997.4500 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 92.000000 $805.0000 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 91.000000 $733.4600 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 92.000000 $2009.2800 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 91.000000 $2629.9000 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 91.000000 $5927.7400 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 91.488889 $2335.7100 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.533333 $118.5600 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 3.066666 $366.7700 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 5 9 16.000000 $800.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 141 159 298.626220 $14931.3100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 9.513698 $713.5300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 7.300782 $547.5600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 4.508220 $338.1200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 16 14.311740 $1073.3900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 11 12 18.000000 $999.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 126 126 158.563139 $11892.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 59 59 72.240316 $5418.0200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 33 34 30.065754 $2254.9300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 159 160 288.313697 $16001.4200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 81 96 114.579450 $8593.4600 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 12.571429 $628.5700 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.433333 $22.1200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 3.000000 $153.1500 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 2 3 0.389041 $58.3700 $150.0200
PSTH -97001 EVAL BY LICENSED PT, INITIAL 9 9 162.085921 $8274.4900 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.022222 $15.9500 $15.6000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.079452 $4.0600 $51.0800
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 13 123.309210 $6294.9400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 62.000000 $3165.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 447 766 2348.736193 $104492.2100 $44.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 13 16.688520 $83444.0000 $5000.0800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 11 55.333377 $2766.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 164 180 123.291875 $6164.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 2 1.133334 $28.3400 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 112 231 618.306272 $30915.3000 $50.0000
CONIP -CONIP CONSULT, PHONE 3 5 8.433335 $210.8400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 10 97.500000 $2437.5100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1042 1353 10072.616352 $503631.3600 $50.0000
INTR -T1013 INTERPRETER 80 116 808.924004 $40446.2500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1090 1811 12295.914265 $122959.2700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 36 210.242853 $15019.7800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 102 148 1064.233823 $76028.8800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 21.000000 $1200.3600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 2.521156 $163.8700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.011111 $119.8800 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.252055 $59.7800 $237.1600
SENS -V5264 EARMOLD 5 6 95.226484 $1714.0800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 144 181 1493.328558 $106683.5200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 8 8 117.071430 $1624.9500 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 124 150 975.536499 $487.7700 $0.5000
TRAV -TRAVS Travel by mile 1128 2054 22264.291872 $9907.6200 $0.4500
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Subtotal (Total Children Is Unduplicated) 1227 6324 50342.857175 $1006014.5500 $19.9800
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Total 7184 52896.300504 $1118046.5500 $21.1400
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Number of Children (Unduplicated) With at Least One Authorization 1306