Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 3482 FSPSA's found of which 19 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.142857 $5.2900 $37.0100
SCTT -SCTT SERVICE COORDINATOR TRAVEL 9 13 83.220239 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 2 0.714285 $26.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 9 16 84.077381 $31.7200 $0.3800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 4 119.433333 $5792.5200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.316667 $14.9100 $47.0900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.266667 $2.7800 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 9 3.205558 $70.3700 $21.9500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.450000 $94.4500 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.505556 $19.4000 $38.3700
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 8 2.772224 $129.7500 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 2.893076 $346.0300 $119.6100
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 2.000000 $100.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 4 4 25.911111 $1295.5600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 5.377777 $403.3300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 14 12.683334 $951.2600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 52 72 205.729308 $15429.7600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 3.916667 $293.7500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 42 53 42.761112 $3207.0900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 78 103 92.068199 $5109.8400 $55.5000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 3 3.116667 $233.7500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 38 39 63.438506 $3520.8400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 12 12 16.788812 $1259.1600 $75.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.177778 $9.0800 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.400000 $20.4200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 6.066667 $309.7100 $51.0500
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Subtotal (Total Children Is Unduplicated) 170 346 611.279019 $38613.7400 $63.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 9 3.636074 $18180.5000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.505556 $25.2800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 91 93 42.704032 $2135.2600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 1.238096 $88.6600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 1.777093 $425.0800 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 66 76 249.877094 $12493.8600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 1.766667 $44.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 267 407 563.846905 $28192.3600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 30 39 50.955554 $1273.8900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 6.571428 $481.8200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 30 143.171432 $3579.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 693 1002 6422.479746 $321124.1000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 683 1277 6424.418379 $64244.2100 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.205556 $78.3600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 3.166667 $750.8900 $237.1200
SENS -V5264 EARMOLD 8 8 7.083334 $127.5000 $18.0000
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 89 146 747.286506 $373.6400 $0.5000
TRAV -TRAVS Travel by mile 2 2 1525.719842 $678.9500 $0.4500
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Subtotal (Total Children Is Unduplicated) 719 3120 16197.409961 $454297.8100 $28.0500
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Total 3482 16892.766361 $492943.2600 $29.1800
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Number of Children (Unduplicated) With at Least One Authorization 722