Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 4417 FSPSA's found of which 1 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
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 0.319054 $11.8100 $37.0100
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Subtotal (Total Children Is Unduplicated) 2 2 0.319054 $11.8100 $37.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 2.260503 $109.6300 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.511111 $23.9200 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 1.388889 $166.1100 $119.6000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 38 45 26.342854 $1344.7900 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 100 104 58.261902 $2974.2600 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 63 70 21.233331 $1083.9500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 82 85 117.999871 $6023.9000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.511111 $26.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 94 113 120.208724 $6136.6500 $51.0500
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Subtotal (Total Children Is Unduplicated) 281 429 348.718296 $17889.3000 $51.3000
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 2 3.066667 $153.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 17 41 27.923809 $1396.1900 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 7 14 3.866665 $193.3300 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 9.571429 $239.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 162 201 1853.071417 $46326.8800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1265 1533 12664.496016 $633225.8700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1196 1511 12663.926717 $126639.4700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 181 225 1554.226982 $111034.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 12 13 93.928572 $5372.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 165 204 1517.016664 $108375.7700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 18 19 137.714288 $7871.7500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.022223 $242.4100 $237.1400
SENS -V5264 EARMOLD 1 2 1.388889 $25.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 167 207 1323.761914 $94569.6100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 12.642857 $723.1700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 45.939683 $637.6400 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1 1 8.285714 $4.1400 $0.5000
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Subtotal (Total Children Is Unduplicated) 1571 3986 31921.850506 $1137030.6500 $35.6200
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Total 4417 32270.887856 $1154931.7500 $35.7900
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Number of Children (Unduplicated) With at Least One Authorization 1572