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 3096 FSPSA's found of which 227 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 22 30 112.089685 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 30 112.089685 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
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 9 9 4.716665 $222.1000 $47.0900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 0.757610 $19.3400 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 60.000000 $2808.0000 $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 2 2 1.083333 $81.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.082877 $6.2200 $75.0200
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 6 1.630290 $90.4800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.252055 $18.9100 $75.0100
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.252055 $18.9100 $75.0100
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 20 23 20.395499 $3059.3100 $150.0000
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) 113 136 178.813473 $10794.2600 $60.3700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 16 4.251293 $21257.0000 $5000.1300
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 10.950000 $784.1300 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 47 51 32.655558 $1632.7900 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 359 472 596.182353 $29809.1100 $50.0000
CONIP -CONIP CONSULT, PHONE 1 2 4.666666 $116.6700 $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 127 181 1013.369044 $50668.5100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 672 1366 7313.443089 $73134.4800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 11.561904 $825.9800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 22 27 174.126983 $12439.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.142857 $179.6500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 57.000000 $13515.8400 $237.1200
SENS -V5264 EARMOLD 3 4 117.933333 $2122.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 50 57 378.235101 $27021.1600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 8.285714 $115.0100 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 415 686 4459.093957 $2229.5400 $0.5000
TRAV -TRAVS Travel by mile 24 43 174.280950 $77.5500 $0.4400
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Subtotal (Total Children Is Unduplicated) 973 2930 14437.616102 $239851.7200 $16.6100
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Total 3096 14728.519260 $250645.9900 $17.0200
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Number of Children (Unduplicated) With at Least One Authorization 979