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 2780 FSPSA's found of which 10 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 57 59 111.185009 $4113.8700 $37.0000
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Subtotal (Total Children Is Unduplicated) 57 59 111.185009 $4113.8700 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 5.142857 $240.6900 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.295890 $35.3900 $119.6000
EXIT -EXIT EXIT ASSESSMENT 16 16 10.045139 $502.2600 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.142466 $7.2700 $51.0600
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 3 3 2.888889 $433.3400 $150.0000
SCREEN-T1023 SCREENING 24 25 16.272222 $813.6100 $50.0000
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) 46 50 35.001161 $2043.4600 $58.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.084932 $424.5000 $4998.1200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 9 11.573015 $578.6500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 9 11.984128 $599.2200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 2.633333 $188.5700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.065753 $15.7400 $239.3700
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 86 193 309.250805 $15462.6000 $50.0000
CONIP -CONIP CONSULT, PHONE 18 41 57.209523 $1430.2300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 0.876208 $21.9100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 222 273 2132.019039 $106601.1100 $50.0000
INTR -T1013 INTERPRETER 33 35 160.255312 $8012.7800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1035 1608 11558.834813 $115588.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 41 50 189.561907 $13542.3000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 9 10 34.178572 $1955.0100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 41 51 231.685715 $16551.6100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 9 44.564287 $2547.2800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 13 4.672146 $303.7000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 15.428571 $3658.4300 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.131507 $31.1800 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 0.128767 $61.0800 $474.3600
SENS -V5264 EARMOLD 5 8 10.711112 $192.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 130 160 772.269057 $55170.8900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 13 185.571429 $2575.7300 $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) 1080 2671 15851.464101 $347805.9600 $21.9400
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Total 2780 15997.650271 $353963.2900 $22.1300
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Number of Children (Unduplicated) With at Least One Authorization 1152