Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 4776 FSPSA's found of which 63 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 3 5 6.444444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 5 6.444444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 1.677779 $32.2200 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.677779 $17.4800 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.677779 $14.6800 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.677779 $36.6500 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 1.427778 $93.0100 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 1.644445 $37.6600 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.216667 $5.5300 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.722223 $33.8000 $46.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.216667 $25.9200 $119.6200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 20 30 96.855552 $4842.7800 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.100000 $5.1100 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.505556 $25.8100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.6900 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.266667 $13.6200 $51.0600
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Subtotal (Total Children Is Unduplicated) 30 58 109.038893 $5202.9400 $47.7200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.433333 $2166.5000 $4999.6200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.461112 $73.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 211 254 47.700628 $2385.0200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 74 84 17.918525 $447.9500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 246 598 1164.165681 $58208.3000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 13 14.300360 $357.5100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 28 31 46.125178 $2306.2500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 27 38.082540 $1904.1200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 36 38 46.541270 $2327.0600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.714286 $42.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1113 1480 10178.342816 $508917.2300 $50.0000
INTR -T1013 INTERPRETER 9 9 182.714286 $9135.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 220 302 2064.893646 $147516.0600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 278 399 2751.057934 $196535.5800 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.216667 $51.3800 $237.1600
SENS -V5264 EARMOLD 3 3 1.622223 $29.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 589 795 6150.168240 $439368.1500 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 503 675 3330.066634 $1665.0300 $0.5000
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Subtotal (Total Children Is Unduplicated) 1655 4713 26037.525359 $1373436.9700 $52.7500
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Total 4776 26153.008696 $1378639.9000 $52.7100
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Number of Children (Unduplicated) With at Least One Authorization 1659