Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5700 FSPSA's found of which 16 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 1 1 0.038889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.038889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 68 87 19.447261 $943.1800 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 12 14 4.263546 $93.5800 $21.9500
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 4.044444 $189.2800 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 14.509741 $1735.3600 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 14 15 16.131660 $806.5800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 105 106 42.377378 $2118.8500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 0.032874 $2.4800 $75.2900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.010958 $0.8300 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.511111 $38.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 0.054944 $3.0500 $55.5500
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 143 143 0.924990 $69.5300 $75.1700
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 20 20 0.243829 $18.3200 $75.1100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 177 178 2.514094 $139.6700 $55.5500
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 19 19 0.095884 $7.2100 $75.1700
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.011111 $50.5600 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 15 19 38.268222 $1953.6000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 35 37 27.667504 $1412.4200 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 16 17 2.276712 $341.5100 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 15 17 4.447035 $227.0200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 39 42 22.826179 $1165.2800 $51.0500
SCREEN-T1023 SCREENING 17 20 5.191020 $259.5600 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.249315 $12.7300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 44 46 21.849466 $1115.4000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.249315 $12.7300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 4 4 0.279452 $13.9800 $50.0100
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Subtotal (Total Children Is Unduplicated) 428 814 229.478045 $12730.9900 $55.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 76 96 24.976108 $124882.0000 $5000.0600
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.041096 $2.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 90 120 80.406214 $4020.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 17.851674 $446.2900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 329 791 1601.100309 $80054.8300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 6 12.666666 $316.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 6.116667 $305.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 16 16 13.200001 $660.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.233333 $55.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 45 53 1740.857139 $43521.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 426 549 4197.206332 $209860.3000 $50.0000
INTR -T1013 INTERPRETER 20 28 40.119310 $2005.9800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 549 1084 6071.325817 $60713.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 125 167 1528.027496 $109162.3000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 28.766667 $1645.4600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 162 220 1871.447439 $133696.2200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.156164 $8.9300 $57.1700
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 0.498630 $118.2300 $237.1100
SENS -V5264 EARMOLD 2 3 1.221918 $21.9900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 201 267 2316.564729 $165495.4300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.285714 $245.1400 $57.2000
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 95 140 482.433111 $241.2200 $0.5000
TRAV -TRAVS Travel by mile 571 1328 260971.255341 $116132.2200 $0.4500
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Subtotal (Total Children Is Unduplicated) 676 4885 281012.757875 $1053611.8200 $3.7500
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Total 5700 281242.274809 $1066342.8200 $3.7900
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Number of Children (Unduplicated) With at Least One Authorization 676