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 4181 FSPSA's found of which 1479 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 5 5 4.011111 $148.4100 $37.0000
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Subtotal (Total Children Is Unduplicated) 5 5 4.011111 $148.4100 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 62 62 29.455552 $439.7700 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 69 71 29.072221 $558.1800 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 62 63 29.966663 $312.2500 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 61 62 29.449997 $257.6800 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.205556 $1.6600 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 62 62 29.455552 $643.3000 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 33 33 14.905553 $970.9300 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 60 61 28.444441 $651.3700 $22.9000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 7 9 5.588888 $285.3100 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.022222 $52.1800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 11 7.500000 $382.8800 $51.0500
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Subtotal (Total Children Is Unduplicated) 113 436 205.066645 $4555.5100 $22.2100
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 290 590 562.778168 $28138.8700 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 2 22.374603 $1118.7300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 376 509 5346.690449 $267334.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1199 2268 1634.448905 $16344.4500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 70 74 641.726198 $45844.9200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.428571 $138.9200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 87 98 580.300802 $41456.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 4.571429 $261.3000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 137 152 1130.683345 $80776.0300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 6.428571 $89.2300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1433 3740 9962.032228 $485513.7900 $48.7400
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Total 4181 10171.109984 $490217.7100 $48.2000
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Number of Children (Unduplicated) With at Least One Authorization 1450