Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 2906 FSPSA's found of which 1 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 34 38 26.672218 $986.8600 $37.0000
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Subtotal (Total Children Is Unduplicated) 34 38 26.672218 $986.8600 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 0.443837 $20.7700 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 14 9.231507 $1104.1000 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 3 4 0.175342 $8.7700 $50.0200
EXIT -EXIT EXIT ASSESSMENT 5 5 0.090412 $4.5200 $49.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 0.143985 $10.8100 $75.0600
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 0.075341 $5.6600 $75.0600
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 0.268492 $20.1500 $75.0300
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 0.010958 $0.6100 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 203 207 3.660202 $274.8700 $75.1000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 84 84 0.649449 $48.8800 $75.2600
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 0.304085 $22.8900 $75.2800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 43 43 0.320683 $17.8400 $55.6400
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 58 58 0.649291 $48.7800 $75.1300
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 12 14 20.223483 $1032.4000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 12 12 1.814994 $92.6600 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 2 2 6.066667 $910.0100 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 13 15 14.003968 $714.9000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 9 9 1.047411 $53.4600 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 47 50 42.744945 $2182.1400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.233333 $11.9100 $51.0400
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Subtotal (Total Children Is Unduplicated) 334 596 102.158385 $6586.1200 $64.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.026104 $5130.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 6 3.961110 $198.0500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.444444 $72.2200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 27 34 16.609646 $830.4800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 11 7.800001 $195.0000 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 67 139 161.579405 $8078.9600 $50.0000
CONIP -CONIP CONSULT, PHONE 41 85 140.149604 $3503.7500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 17.714286 $442.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 134 160 1195.741609 $59787.1600 $50.0000
INTR -T1013 INTERPRETER 2 2 2.972146 $148.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 10 17 187.571426 $1875.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 179 257 1460.296037 $104323.4900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 58 66 437.199605 $25007.8200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 154 242 1423.283338 $101679.2900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 33 39 233.323413 $13336.7700 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 1.380822 $327.4400 $237.1300
SENS -V5264 EARMOLD 14 17 12.981887 $233.6700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 518 685 4844.455325 $346088.1200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 18.446032 $256.0300 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 322 475 4120.098833 $2060.0400 $0.5000
TRAV -TRAVS Travel by mile 11 19 133.043652 $59.2000 $0.4500
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Subtotal (Total Children Is Unduplicated) 754 2272 14421.078725 $673635.1800 $46.7100
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Total 2906 14549.909328 $681208.1600 $46.8200
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Number of Children (Unduplicated) With at Least One Authorization 883