Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 4293 FSPSA's found of which 309 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 32 120.756351 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.107143 $3.9600 $36.9900
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Subtotal (Total Children Is Unduplicated) 24 33 120.863494 $3.9600 $0.0300
Screening, Eval, and Assessment, Class # 02
AACIO -92597GO AAC INITIAL EVAL BY LICENSED OT 1 1 0.005479 $0.5600 $103.0300
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 0.433333 $44.4700 $102.6200
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 21 24 10.874583 $527.4200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 19 20 8.344443 $392.9300 $47.0900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.355556 $7.8100 $21.9500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.411111 $26.7800 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 1.009665 $25.7800 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 10 72.256348 $3381.5900 $46.8000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 3 0.961795 $48.0900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 46 54 75.435250 $3771.7600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.010959 $0.8300 $75.2800
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.283333 $15.7200 $55.4900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 5 3.649999 $273.7500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 5 0.760655 $57.0500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 10 2.304909 $127.9200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 2 0.756165 $56.7200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 2.038812 $113.1500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 2 0.756165 $56.7200 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.800000 $40.8400 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 21 24 20.395499 $3059.3100 $150.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 5 5 3.569559 $182.2300 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.633333 $9.8800 $15.6000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.043836 $2.2400 $51.0100
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.966667 $49.3500 $51.0500
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Subtotal (Total Children Is Unduplicated) 149 184 207.068412 $12273.7200 $59.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 33 8.602131 $43011.5000 $5000.1000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.733333 $36.6700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 11.972222 $857.3300 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 48 52 33.677780 $1683.9000 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 360 473 596.560131 $29828.0000 $50.0000
CONIP -CONIP CONSULT, PHONE 1 2 4.666666 $116.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.833333 $45.8300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 12 15 78.437300 $3921.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 907 1231 7733.695581 $386685.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 673 1369 7322.395469 $73224.0000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 11 72.333334 $5167.4900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 42 52 337.750791 $24128.9600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 9.714286 $555.2700 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 57.000000 $13515.8400 $237.1200
SENS -V5264 EARMOLD 4 5 117.933333 $2122.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 88 620.992244 $44363.7300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 17.571428 $243.8900 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 416 690 4483.951100 $2241.9700 $0.5000
TRAV -TRAVS Travel by mile 24 43 174.280950 $77.5500 $0.4400
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Subtotal (Total Children Is Unduplicated) 984 4076 21684.101412 $631828.4000 $29.1400
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Total 4293 22012.033318 $644106.0800 $29.2600
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Number of Children (Unduplicated) With at Least One Authorization 989