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
Eligibility Filter: Program Patients
With the filters selected there were 10051 FSPSA's found of which 15 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 2 3 2.311111 $85.5100 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.928571 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 95 106 210.811898 $7800.0200 $37.0000
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Subtotal (Total Children Is Unduplicated) 97 110 214.051580 $7885.5300 $36.8400
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 23 28 114.560535 $5556.1800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 0.411111 $19.3600 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 94.066667 $1404.4200 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 108.031746 $2074.2100 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 94.066667 $980.1800 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 94.066667 $2064.7600 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 5 95.829833 $838.5100 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 91.000000 $733.4600 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 95.829833 $2092.9300 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 94.066667 $2718.5300 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 91.000000 $5927.7400 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 3.066667 $70.2300 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 91.733333 $2341.9500 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 8 5.616665 $262.8500 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 4.077777 $487.6900 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 6 11 20.000000 $1000.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 177 201 380.631699 $19031.5800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.002740 $0.2000 $73.9100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 17 17 15.545434 $1165.9100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 11 11 7.314480 $548.5900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 6.512330 $488.4200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 20 16.822698 $1261.7100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 21 26.015069 $1443.8300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 182 182 271.149437 $20336.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 79 79 103.754015 $7781.5400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 46 48 39.097262 $2932.2900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 224 226 367.338156 $20387.2800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 110 132 143.163009 $10737.2300 $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 5 5 36.022222 $1838.9300 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 5 6 0.761644 $114.2700 $150.0300
PSTH -97001 EVAL BY LICENSED PT, INITIAL 11 12 162.728539 $8307.3000 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.961111 $30.5900 $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 25 26 181.260884 $9253.3700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 62.083333 $3169.3500 $51.0500
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Subtotal (Total Children Is Unduplicated) 622 1086 2934.672444 $138261.6300 $47.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 26 112.235856 $561181.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.252055 $12.6100 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 25 27 90.170690 $4508.5500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.505556 $36.2100 $71.6200
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 0.654719 $156.6300 $239.2300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 222 249 159.834198 $7991.6500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 2 1.133334 $28.3400 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 168 376 956.915454 $47845.8100 $50.0000
CONIP -CONIP CONSULT, PHONE 7 17 27.533336 $688.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 12 12 99.214286 $2480.3600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1342 1757 12882.308225 $644116.1700 $50.0000
INTR -T1013 INTERPRETER 89 127 857.138289 $42856.9600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1462 2501 16667.884333 $166679.0200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 59 73 450.742852 $32201.1200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.857143 $220.6300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 149 213 1574.098897 $112453.6500 $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 4 4 1.599999 $189.6800 $118.5500
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.504110 $119.5600 $237.1600
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.166667 $39.5300 $237.1700
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 4 4 1.465830 $695.1900 $474.2600
SENS -V5264 EARMOLD 15 16 100.530593 $1809.5500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 286 369 3135.247596 $223982.3800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 7.571429 $433.0800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 15 15 204.642859 $2840.4400 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 170 208 1313.464002 $656.7300 $0.5000
TRAV -TRAVS Travel by mile 1518 2843 31014.421589 $13801.4300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1654 8855 69687.615053 $1869389.3100 $26.8300
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Total 10051 72836.339077 $2015536.4700 $27.6700
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Number of Children (Unduplicated) With at Least One Authorization 1757