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 778 FSPSA's found of which 46 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 -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.361111 $6.9300 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.361111 $3.7600 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.361111 $3.1600 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.361111 $7.8900 $21.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.361111 $16.9000 $46.8000
EXIT -EXIT EXIT ASSESSMENT 14 14 5.483485 $274.1800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.766667 $38.3400 $50.0000
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 1 1 0.300000 $45.0000 $150.0000
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Subtotal (Total Children Is Unduplicated) 17 21 8.355707 $396.1600 $47.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.161904 $10809.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.361111 $18.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 45 64 1.335568 $66.7800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.005556 $0.1400 $25.2000
CONIF -CONIF CONSULT, FACE TO FACE 25 37 29.866119 $1493.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 165 183 1250.414291 $62520.7600 $50.0000
INTR -T1013 INTERPRETER 29 30 1146.214288 $57310.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 57 442.538097 $31614.9500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 60 63 441.509529 $31541.4600 $71.4400
SENS -V5264 EARMOLD 1 1 0.361111 $6.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 146 171 1263.795233 $90285.6200 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 120 146 774.532347 $387.2600 $0.5000
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Subtotal (Total Children Is Unduplicated) 420 756 5353.095154 $286055.0200 $53.4400
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Total 777 5361.450861 $286451.1800 $53.4300
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Number of Children (Unduplicated) With at Least One Authorization 427