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 1859 FSPSA's found of which 53 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
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Subtotal (Total Children Is Unduplicated) 7 14 48.046032 $111.0000 $2.3100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 64.000000 $3104.0000 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.533333 $71.7600 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.526332 $182.5500 $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 -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 2.033333 $152.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 5.077778 $380.8400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 10 4.166589 $312.4900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 1.522222 $84.4800 $55.5000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 2 2.133334 $160.0100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 2.500000 $138.7500 $55.5000
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) 37 48 122.915474 $6656.9500 $54.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.261111 $1305.5000 $4999.7900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 46 47 20.486680 $1024.3300 $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 191 265 391.217287 $19560.8600 $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 4 5 11.357143 $283.9300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 36 40 343.226192 $17161.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 514 906 4808.234081 $48082.3800 $10.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.022222 $242.3800 $237.1100
SENS -V5264 EARMOLD 2 2 5.111111 $92.0000 $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 270 436 3233.845395 $1616.9200 $0.5000
TRAV -TRAVS Travel by mile 7 8 3148.448413 $1401.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 676 1797 12137.399350 $99147.9500 $8.1700
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Total 1859 12308.360856 $105915.9000 $8.6100
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Number of Children (Unduplicated) With at Least One Authorization 680