Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 3028 FSPSA's found of which 66 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 3 3.000000 $111.0000 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 11 45.046032 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 25.000000 $925.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 8 16 73.046032 $1036.0000 $14.1800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 64.000000 $3104.0000 $48.5000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.511111 $19.6100 $38.3700
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.872222 $87.6200 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 2.187443 $261.6100 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 4 10.000000 $500.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 11 12 22.122552 $1106.1400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 1.288889 $96.6700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 13 72.111109 $5408.3200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 43 48 393.644442 $29523.3200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.383333 $178.7500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 32 61 85.571909 $6417.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 39 42 37.648409 $2089.4700 $55.5000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 8 6.911036 $518.3400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 29 50.422146 $2798.4300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 6.043834 $453.3000 $75.0000
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 2 2 1.433334 $215.0100 $150.0100
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 4.866667 $248.4500 $51.0500
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Subtotal (Total Children Is Unduplicated) 137 243 765.018436 $53176.8500 $69.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 2.784323 $13921.5000 $4999.9600
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 53 54 23.208902 $1160.4400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.444444 $31.8200 $71.6000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 42 55 140.546063 $7027.3000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 0.594445 $14.8600 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 191 267 397.117287 $19855.8600 $50.0000
CONIP -CONIP CONSULT, PHONE 17 22 20.022223 $500.5600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 10.082540 $739.2500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 22 24 121.619049 $3040.4800 $25.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 2.000000 $100.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 681 958 6752.885620 $337644.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 516 911 4846.697573 $48467.0100 $10.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.533333 $363.5800 $237.1100
SENS -V5264 EARMOLD 5 5 6.122222 $110.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 0.500000 $35.7200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.000000 $27.7600 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 274 444 3276.727935 $1638.3600 $0.5000
TRAV -TRAVS Travel by mile 7 8 3148.448413 $1401.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 689 2769 18753.334372 $436080.3500 $23.2500
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Total 3028 19591.398840 $490293.2100 $25.0300
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Number of Children (Unduplicated) With at Least One Authorization 698