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 2155 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
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
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Subtotal (Total Children Is Unduplicated) 9 14 83.363096 $5.2900 $0.0600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 4 119.433333 $5792.5200 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.266667 $2.7800 $10.4200
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.561112 $26.2600 $46.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.554186 $66.2800 $119.6000
EXIT -EXIT EXIT ASSESSMENT 4 4 25.911111 $1295.5600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.544444 $40.8300 $74.9900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 15 2.238893 $167.9500 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.772222 $57.9200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 14 2.572226 $142.7800 $55.5100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 4.000000 $222.0000 $55.5000
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) 29 48 162.920861 $8124.5700 $49.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.113851 $569.0000 $4997.7600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.505556 $25.2800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 81 83 37.815141 $1890.8000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 1.226985 $87.8700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 0.622222 $148.8300 $239.1900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 65 75 248.377094 $12418.8600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 1.766667 $44.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 267 403 554.713572 $27735.6900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 30 39 50.955554 $1273.8900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 5.161904 $378.4700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 24.166667 $604.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 38 47 195.685715 $9784.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 683 1274 6421.994569 $64219.9800 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.200000 $13.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.011111 $239.7500 $237.1200
SENS -V5264 EARMOLD 2 2 3.144444 $56.6000 $18.0000
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 88 144 744.124602 $372.0600 $0.5000
TRAV -TRAVS Travel by mile 2 2 1525.719842 $678.9500 $0.4500
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Subtotal (Total Children Is Unduplicated) 708 2093 9817.305496 $120541.6500 $12.2800
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Total 2155 10063.589453 $128671.5100 $12.7900
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Number of Children (Unduplicated) With at Least One Authorization 711