Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 2340 FSPSA's found of which 17 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 1 1 2.233333 $82.6300 $37.0000
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Subtotal (Total Children Is Unduplicated) 1 1 2.233333 $82.6300 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 3.000000 $26.2500 $8.7500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 2.966667 $75.7400 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.246575 $11.5400 $46.8000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.008219 $0.4100 $49.8800
EXIT -EXIT EXIT ASSESSMENT 4 4 1.166666 $58.3300 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 1.079756 $55.1200 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 1 1 0.066667 $10.0100 $150.0700
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.044444 $2.2700 $51.0000
SCREEN-T1023 SCREENING 7 7 2.522678 $126.1300 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.057534 $2.9400 $51.0200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.055556 $53.8900 $51.0500
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Subtotal (Total Children Is Unduplicated) 18 22 12.214762 $422.6100 $34.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.288889 $1444.5000 $5000.1900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 7 13.033333 $651.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 92 121 64.430145 $3221.5200 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 409 1148 2670.515020 $133526.0800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 32 203.403176 $10170.1600 $50.0000
INTR -T1013 INTERPRETER 7 10 50.576193 $2528.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 4 34.552381 $345.5200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 17 118.407141 $8459.0100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 3 9.638096 $551.3000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 11 16 130.861905 $9348.7700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 13.142857 $751.2500 $57.1600
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 45 57 339.465475 $24251.4000 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 436 809 8686.119186 $4343.0500 $0.5000
TRAV -TRAVS Travel by mile 63 90 1063.353963 $473.1900 $0.4400
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Subtotal (Total Children Is Unduplicated) 611 2317 13399.787760 $200102.2100 $14.9300
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Total 2340 13414.235855 $200607.4600 $14.9500
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Number of Children (Unduplicated) With at Least One Authorization 611