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 1397 FSPSA's found
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 15 17 11.833332 $437.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 15 17 11.833332 $437.8300 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 2.835007 $339.0700 $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 -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.252055 $18.9100 $75.0100
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 9 11 0.065749 $4.9500 $75.2900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 0.027396 $2.0600 $75.2800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 0.021916 $1.6500 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 0.027395 $1.5300 $55.7000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 5 6 13.413068 $684.7400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 5 5 0.699086 $35.6900 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 8 9 8.463491 $432.0600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 5 5 0.541171 $27.6200 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 19 20 14.087302 $719.1600 $51.0500
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Subtotal (Total Children Is Unduplicated) 61 85 40.710348 $2281.3400 $56.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.905556 $4528.0000 $5000.2400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 3.000000 $150.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.022222 $51.1100 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 36 46 326.428570 $16321.4400 $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 67 89 533.097617 $38084.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 14 15 86.500000 $4947.8100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 68 97 559.783332 $39990.9000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 41.999999 $2400.7300 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.279452 $66.2800 $237.1600
SENS -V5264 EARMOLD 5 7 6.133332 $110.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 202 252 1782.895230 $127370.1300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 0.588889 $8.1700 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 314 466 4025.936930 $2012.9600 $0.5000
TRAV -TRAVS Travel by mile 11 19 133.043652 $59.2000 $0.4500
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Subtotal (Total Children Is Unduplicated) 528 1295 8018.297009 $250734.1400 $31.2700
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Total 1397 8070.840689 $253453.3100 $31.4000
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Number of Children (Unduplicated) With at Least One Authorization 551