Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 4168 FSPSA's found of which 27 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 79 84 163.107235 $6035.0100 $37.0000
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Subtotal (Total Children Is Unduplicated) 79 84 163.107235 $6035.0100 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 15.714286 $735.4300 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 17 22 14.707230 $1759.0100 $119.6000
EXIT -EXIT EXIT ASSESSMENT 17 17 10.132810 $506.6400 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 0.421918 $21.5400 $51.0600
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 3 3 2.888889 $433.3400 $150.0000
SCREEN-T1023 SCREENING 26 27 16.888888 $844.4400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.131507 $2.0500 $15.6000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.213698 $10.9100 $51.0500
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Subtotal (Total Children Is Unduplicated) 67 78 61.099226 $4313.3500 $70.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.084932 $424.5000 $4998.1200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 12 15.050792 $752.5400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 20 25.839683 $1291.9900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 5.500000 $393.8600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 0.509589 $121.9200 $239.2500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 162 170 44.792425 $2239.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 0.705555 $17.6400 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 86 194 312.317472 $15615.9400 $50.0000
CONIP -CONIP CONSULT, PHONE 18 41 57.209523 $1430.2300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 5 206.285716 $5157.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 108 134 2910.553026 $72763.8200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 673 843 6472.878622 $323644.4000 $50.0000
INTR -T1013 INTERPRETER 33 35 160.255312 $8012.7800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1038 1612 11581.396718 $115814.1300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 128 153 599.023818 $42794.2000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 32 37 160.828573 $9199.3900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 161 201 722.150409 $51590.3000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 62 72 247.011110 $14119.1300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 13 4.672146 $303.7000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.216438 $25.6600 $118.5400
SENS -V5050 IN EAR MONAURAL HEARING AID 12 12 24.295696 $5761.0400 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.131507 $31.1800 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 5 5 0.509589 $241.7200 $474.3400
SENS -V5264 EARMOLD 47 62 116.650351 $2099.7100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 283 345 1597.126214 $114098.6500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 20 20 226.566668 $3144.7500 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1 4 48.000000 $24.0000 $0.5000
TRAV -TRAVS Travel by mile 3 3 24.276190 $10.8000 $0.4400
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Subtotal (Total Children Is Unduplicated) 1210 4006 25564.838074 $791124.7800 $30.9500
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Total 4168 25789.044535 $801473.1400 $31.0800
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Number of Children (Unduplicated) With at Least One Authorization 1303