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: 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 4401 FSPSA's found of which 75 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 43 54 14.675972 $711.8000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 11 13 5.550383 $121.8300 $21.9500
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 5.000001 $234.0000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 8.521853 $1019.2200 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 11 11 4.235618 $211.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 63 64 62.212522 $3110.6600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.010958 $0.8300 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 2.868101 $215.1100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.016437 $0.9200 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 96 96 0.522190 $39.2800 $75.2200
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 17 17 0.084927 $6.3800 $75.1500
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 107 108 2.334996 $129.6700 $55.5300
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 29 29 0.152044 $11.4400 $75.2200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.100000 $5.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 13 15 56.512372 $2884.9600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 27 27 23.392521 $1194.2000 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 49 51 15.986432 $2398.0100 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 10 10 2.802664 $143.0800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 23 23 8.533965 $435.6700 $51.0500
SCREEN-T1023 SCREENING 12 13 5.621385 $281.0800 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.142466 $7.2700 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 30 30 21.683311 $1106.9400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.065753 $3.3600 $51.0900
VISF -92499 VISION EVALUATION FUNCTIONAL 3 3 0.695891 $34.8000 $50.0100
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Subtotal (Total Children Is Unduplicated) 324 582 241.722762 $14307.2700 $59.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 53 69 24.731909 $123661.0000 $5000.0600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 59 65 43.387440 $2169.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 6.690356 $167.2600 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 191 491 851.537802 $42577.0400 $50.0000
CONIP -CONIP CONSULT, PHONE 1 2 6.133334 $153.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 34 35 1001.285713 $25032.1600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 389 521 3824.635110 $191231.9700 $50.0000
INTR -T1013 INTERPRETER 13 19 37.154108 $1857.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 411 719 5859.709770 $58597.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 131 162 1641.504427 $117269.1900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 22.571429 $1291.0800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 163 210 1917.069831 $136955.6200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 49.571428 $2833.5100 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.712329 $168.9000 $237.1100
SENS -V5264 EARMOLD 3 4 1.084931 $19.5300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 206 258 2417.281642 $172690.8400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 18.285714 $253.8100 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 252 390 2107.258370 $1053.6300 $0.5000
TRAV -TRAVS Travel by mile 396 862 162099.189303 $72134.1500 $0.4500
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Subtotal (Total Children Is Unduplicated) 629 3819 181929.794946 $950117.1800 $5.2200
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Total 4401 182171.517708 $964424.4500 $5.2900
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Number of Children (Unduplicated) With at Least One Authorization 633