Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 8111 FSPSA's found of which 1545 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 18 18 13.888888 $513.8900 $37.0000
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Subtotal (Total Children Is Unduplicated) 18 18 13.888888 $513.8900 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 283 285 126.740931 $1892.2200 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 293 310 132.505224 $2544.0900 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 278 280 123.624265 $1288.1600 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 277 278 123.579821 $1081.3100 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 4 4 1.250000 $10.0800 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 278 283 124.479820 $2718.6100 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 144 146 63.635385 $4145.1900 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 274 277 122.174265 $2797.7700 $22.9000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 31 36 21.472223 $1096.1600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 9 10 5.011110 $255.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 52 59 51.357144 $2621.7900 $51.0500
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Subtotal (Total Children Is Unduplicated) 488 1968 895.830188 $20451.1800 $22.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.511111 $2555.5000 $4999.8900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 30 43 29.090076 $1454.4900 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 290 591 564.244835 $28212.2000 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 2 22.374603 $1118.7300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1245 1688 16322.061045 $816103.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1217 2346 1684.472714 $16844.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 302 348 2473.569487 $176711.7800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 25.285714 $1446.3400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 460 544 3264.527047 $233217.7400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 9.714287 $555.2600 $57.1600
SENS -V5264 EARMOLD 3 3 0.511111 $9.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 465 540 4109.147654 $293557.6100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.714286 $269.6600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 59.214286 $821.8900 $13.8800
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Subtotal (Total Children Is Unduplicated) 1732 6119 28569.438256 $1572878.7500 $55.0500
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Total 8105 29479.157332 $1593843.8100 $54.0700
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Number of Children (Unduplicated) With at Least One Authorization 1759