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: 04-01-16 and 06-30-16 Date of Report: 08-06-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3709 FSPSA's found of which 2 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 9 14 55.092858 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 14 55.092858 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 3.622222 $175.6800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.794445 $37.4100 $47.0900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.011111 $10.5400 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 42 44 21.389686 $469.5100 $21.9500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.377779 $89.7600 $65.1500
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.005556 $0.2100 $38.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 3.544446 $165.8900 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 3.277702 $392.0300 $119.6000
EXIT -EXIT EXIT ASSESSMENT 7 7 9.333333 $466.6700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 7 7.277778 $545.8400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 18 17.972225 $1347.9400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 57 77 73.947953 $5546.1500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 4.688890 $351.6800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 36 39 42.544450 $3190.8800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 97 125 114.967801 $6380.7900 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 38 38 75.516667 $4191.1800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 15.538889 $1165.4200 $75.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.333333 $17.0200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.533333 $78.2800 $51.0500
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Subtotal (Total Children Is Unduplicated) 207 393 398.677599 $24622.8300 $61.7600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 15 7.144444 $35722.0000 $4999.9700
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.733334 $86.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 89 90 46.876322 $2343.8800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 7.644445 $547.4200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 15 15 4.112993 $983.8500 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 61 78 324.321102 $16216.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 2.694445 $67.3600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 321 474 730.303189 $36515.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 37 52 60.294443 $1507.3600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 15 16 50.976189 $3737.5700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 27 28 147.628571 $3690.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 750 1053 6712.461100 $335623.2200 $50.0000
INTR -T1013 INTERPRETER 1 1 6.857143 $342.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 763 1458 7463.014286 $74630.1800 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.516667 $98.5900 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 2.033333 $482.1400 $237.1200
SENS -V5264 EARMOLD 5 5 4.077778 $73.4000 $18.0000
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Subtotal (Total Children Is Unduplicated) 781 3301 15573.689784 $512668.4800 $32.9200
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Total 3708 16027.460241 $537291.3100 $33.5200
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Number of Children (Unduplicated) With at Least One Authorization 784