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 367 FSPSA's found of which 17 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 3 3.033333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 3 3.033333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.461112 $28.0600 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.461112 $15.2300 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.461112 $12.7900 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.461112 $31.9100 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 1.427778 $93.0100 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.427778 $32.7000 $22.9000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.505556 $23.6600 $46.8000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 3.033333 $151.6700 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 14 12.238893 $389.0100 $31.7800
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.461112 $73.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 47 63 5.788840 $289.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 0.006850 $0.1700 $24.8200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 16 3.088091 $154.3900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.101370 $5.0700 $50.0100
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 3 0.072222 $3.6100 $49.9800
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 58 70 367.642855 $18382.1400 $50.0000
INTR -T1013 INTERPRETER 9 9 182.714286 $9135.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 23 89.923809 $6424.1700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 20 24 120.442859 $8604.4300 $71.4400
SENS -V5264 EARMOLD 2 2 1.405556 $25.3000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 71 86 552.695239 $39484.5500 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 41 49 177.719046 $88.8600 $0.5000
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Subtotal (Total Children Is Unduplicated) 179 350 1503.062135 $82670.9200 $55.0000
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Total 367 1518.334361 $83059.9300 $54.7000
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Number of Children (Unduplicated) With at Least One Authorization 182