Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 5465 FSPSA's found of which 152 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
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.505556 $7.5500 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.866667 $16.6400 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.866667 $9.0300 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.866667 $7.5800 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.866667 $18.9300 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.505556 $32.9300 $65.1500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.505556 $11.5800 $22.9000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.361111 $16.9000 $46.8000
EXIT -EXIT EXIT ASSESSMENT 21 21 9.261263 $463.0700 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 3.066666 $153.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 15 80.307936 $4015.4000 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 0.216666 $11.0600 $51.0300
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 1 1 0.300000 $45.0000 $150.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.427778 $21.8400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.088889 $4.5400 $51.0600
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Subtotal (Total Children Is Unduplicated) 41 55 99.013645 $4835.3800 $48.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.673015 $13365.0000 $4999.9700
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 11.714286 $585.7200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.361111 $18.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 189 239 19.089492 $954.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 34 38 2.416929 $60.4200 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 235 546 1220.003422 $61000.0300 $50.0000
CONIP -CONIP CONSULT, PHONE 12 16 4.974810 $124.3700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1114 1481 10592.749965 $529638.2200 $50.0000
INTR -T1013 INTERPRETER 30 31 1146.225399 $57311.2700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 201 278 2024.647184 $144640.9100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 281 397 2875.490483 $205425.2100 $71.4400
SENS -V5264 EARMOLD 1 1 0.361111 $6.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 559 765 6084.997949 $434712.7600 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1154 1612 12984.623150 $6492.2900 $0.5000
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Subtotal (Total Children Is Unduplicated) 1662 5409 36970.328306 $1454335.1800 $39.3400
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Total 5464 37069.341951 $1459170.5600 $39.3600
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Number of Children (Unduplicated) With at Least One Authorization 1662