Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 3572 FSPSA's found of which 23 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 10 11 987.307936 $36530.3900 $37.0000
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Subtotal (Total Children Is Unduplicated) 10 11 987.307936 $36530.3900 $37.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 7 8 2.913090 $137.1800 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 1.179605 $17.6100 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 5 7.022527 $134.8300 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 1.799087 $18.7500 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 0.992238 $21.7800 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 21 22 3.600457 $31.5100 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 24 25 10.964232 $239.4700 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 0.285388 $8.2500 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.298630 $19.4500 $65.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 19 19 3.362101 $77.0000 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 0.231050 $5.9000 $25.5200
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 9 4.912177 $229.8900 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 9 8.993803 $1075.6600 $119.6000
EXIT -EXIT EXIT ASSESSMENT 52 56 5.539346 $276.9400 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 59.142858 $4435.7200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 0.027397 $2.0600 $75.0100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 17 20 0.073974 $4.0800 $55.1300
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 15 18 13.200393 $990.0000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 15 15 2.906926 $148.4000 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 5 5 0.561643 $84.2400 $149.9900
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 8 7.033701 $359.0700 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.136986 $2.1400 $15.6000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 26 26 28.396706 $1449.6500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 7 8 19.178103 $979.0400 $51.0500
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Subtotal (Total Children Is Unduplicated) 153 288 182.752418 $10748.5900 $58.8200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.323288 $1616.5000 $5000.1900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.477778 $23.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 19 25.015384 $1250.7800 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 4.030159 $288.6000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 0.674505 $48.3000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.606697 $145.1200 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 91 114 158.376885 $7918.8700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 8 8.872225 $221.8100 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 180 362 1203.331758 $60166.6700 $50.0000
CONIP -CONIP CONSULT, PHONE 10 17 36.595239 $914.8900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 3.285714 $82.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 6.000000 $300.0000 $50.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 0.010959 $0.5500 $50.1900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1138 1450 12773.006040 $638651.0600 $50.0000
INTR -T1013 INTERPRETER 8 8 102.862622 $5143.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 94 107 1012.351507 $10123.5300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 25 256.142855 $18298.8800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 15.428571 $882.5200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 28 34 266.741273 $19056.0300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 20.428571 $1167.7000 $57.1600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.316667 $37.5500 $118.5700
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.642542 $152.3700 $237.1400
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 0.323288 $153.3200 $474.2600
SENS -V5264 EARMOLD 10 11 24.426266 $439.6700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 114 132 1209.916665 $86436.5600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 4 32.285714 $448.1300 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 724 922 8034.977741 $4017.4800 $0.5000
TRAV -TRAVS Travel by mile 29 34 235.419765 $104.7600 $0.4400
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Subtotal (Total Children Is Unduplicated) 1213 3273 25432.870678 $858090.8100 $33.7400
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Total 3572 26602.931032 $905369.8000 $34.0300
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Number of Children (Unduplicated) With at Least One Authorization 1230