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 2289 FSPSA's found of which 1 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
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.011111 $10.5400 $10.4200
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.005556 $0.2600 $47.1700
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.244368 $29.2300 $119.6200
EXIT -EXIT EXIT ASSESSMENT 7 7 9.333333 $466.6700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.322222 $24.1700 $74.9900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 15 15 5.477781 $410.8600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.488889 $36.6700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.338889 $25.4200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 20 6.711115 $372.4900 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
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) 35 57 33.088819 $1891.2400 $57.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 2.294444 $11472.0000 $4999.9000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.733334 $86.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 80 81 42.271560 $2113.6400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 7.005556 $501.6700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.505556 $360.1400 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 60 77 323.321102 $16166.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 2.694445 $67.3600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 321 472 727.203189 $36360.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 37 52 60.294443 $1507.3600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 2.966666 $217.5100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 7.980951 $199.5200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 43 51 251.805552 $12590.2900 $50.0000
INTR -T1013 INTERPRETER 1 1 6.857143 $342.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 763 1456 7454.347619 $74543.5200 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.505556 $32.8600 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.011111 $2.6300 $236.8800
SENS -V5264 EARMOLD 1 1 0.033333 $0.6000 $17.9800
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Subtotal (Total Children Is Unduplicated) 770 2217 8892.831560 $156564.9100 $17.6100
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Total 2288 8981.013237 $158456.1500 $17.6400
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Number of Children (Unduplicated) With at Least One Authorization 773