Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 6073 FSPSA's found of which 13 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 15 15 6.530370 $241.6100 $37.0000
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Subtotal (Total Children Is Unduplicated) 15 15 6.530370 $241.6100 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92585 AUD EVOKED RESPONSE (COMP) 10 10 6.237302 $406.3000 $65.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.022222 $47.8400 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.252055 $30.1500 $119.6200
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.488889 $36.6700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 10 10 3.499999 $194.2600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 15 16 4.988887 $374.1900 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 33 38 46.609980 $2379.4400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 128 138 111.147805 $5674.0600 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 76 88 87.824856 $4483.4500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 83 86 61.115074 $3119.9000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 290 329 324.286984 $16554.8300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 15 15 25.608731 $1307.3300 $51.0500
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Subtotal (Total Children Is Unduplicated) 518 738 677.082784 $34908.4300 $51.5600
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.322222 $77.0700 $239.1800
CONIF -CONIF CONSULT, FACE TO FACE 519 824 799.904730 $39995.1400 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 80 82 718.571420 $17964.3100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 909 1065 9683.420565 $484171.7400 $50.0000
INTR -T1013 INTERPRETER 1 1 1.285714 $64.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1056 2583 12526.320878 $125263.2900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 130 145 932.897150 $66646.2200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 10 64.785714 $3705.7400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 146 173 1294.367460 $92469.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 23 24 214.428570 $12256.7600 $57.1600
SENS -V5264 EARMOLD 1 1 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 271 307 2354.983333 $168240.1900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 23.142857 $1323.7700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 20 20 146.472223 $2033.0400 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 28 34 854.608726 $427.3000 $0.5000
TRAV -TRAVS Travel by mile 31 47 465.079365 $206.9600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1329 5320 30081.613149 $1014863.9200 $33.7400
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Total 6073 30765.226303 $1050013.9600 $34.1300
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Number of Children (Unduplicated) With at Least One Authorization 1365