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 4302 FSPSA's found of which 12 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 7 7 3.506666 $129.7400 $37.0000
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Subtotal (Total Children Is Unduplicated) 7 7 3.506666 $129.7400 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 5.292857 $344.7800 $65.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.511111 $23.9200 $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 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.000000 $75.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 0.285714 $15.8600 $55.5200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 0.285714 $21.4400 $75.0200
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 19 20 33.049207 $1687.1700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 53 56 63.001582 $3216.2200 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 38 43 53.097243 $2710.6200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 30 31 20.925395 $1068.2300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 149 168 180.539481 $9216.5300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 12 12 24.147620 $1232.7400 $51.0500
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Subtotal (Total Children Is Unduplicated) 248 344 383.387979 $19717.6600 $51.4300
EI Services, Class # 03
CONIF -CONIF CONSULT, FACE TO FACE 518 820 798.082508 $39904.0300 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 8.857143 $221.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 231 264 2344.475383 $117223.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1044 2534 12243.572466 $122435.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 29 35 297.821429 $21276.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 42.000000 $2402.4000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 45 53 470.550792 $33616.1800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 14 126.714284 $7243.0000 $57.1600
SENS -V5264 EARMOLD 1 1 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 111 126 1079.661901 $77131.1000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.428571 $196.1200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 15 15 123.610317 $1715.7100 $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) 1161 3951 18859.485107 $424018.7600 $22.4800
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Total 4302 19246.379752 $443866.1600 $23.0600
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Number of Children (Unduplicated) With at Least One Authorization 1201