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 2124 FSPSA's found of which 13 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 2 368.000000 $13616.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 2 2 368.000000 $13616.0000 $37.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.033334 $48.6600 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.477778 $7.1300 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.477778 $9.1700 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.087671 $0.9100 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 0.268493 $2.3500 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.180822 $3.9500 $21.8500
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.087671 $2.5300 $28.9100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.180822 $4.1400 $22.9100
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 1.744597 $81.6500 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 5.960470 $712.8800 $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 1 1 13.142857 $985.7200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.010959 $0.8300 $75.2800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 0.016438 $0.9100 $55.3600
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 13.159295 $986.9500 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 0.555556 $28.3600 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 5 5 0.561643 $84.2400 $149.9900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 11 13.416983 $684.9500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 3 3 0.350837 $17.9100 $51.0600
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Subtotal (Total Children Is Unduplicated) 79 109 57.253350 $3940.2000 $68.8200
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) 9 9 7.571995 $378.6100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.477778 $34.2200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.235616 $16.8700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.488889 $116.9400 $239.2100
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 179 360 1198.465091 $59923.3400 $50.0000
CONIP -CONIP CONSULT, PHONE 10 17 36.595239 $914.8900 $25.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 0.010959 $0.5500 $50.1900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 319 390 3438.091792 $171904.8400 $50.0000
INTR -T1013 INTERPRETER 8 8 102.862622 $5143.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 91 104 968.065793 $9680.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 105.142856 $7511.4200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 12.142857 $694.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 7 8 49.719053 $3551.9300 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.136986 $32.4900 $237.1400
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 1 0.241096 $114.3400 $474.2500
SENS -V5264 EARMOLD 2 2 19.942857 $358.9700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 40 43 463.428570 $33107.3800 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 708 900 7820.692027 $3910.3400 $0.5000
TRAV -TRAVS Travel by mile 28 33 201.134051 $89.5000 $0.4400
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Subtotal (Total Children Is Unduplicated) 966 2013 14593.496303 $307266.0600 $21.0500
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Total 2124 15018.749653 $324822.2600 $21.6300
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Number of Children (Unduplicated) With at Least One Authorization 978