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: 07-01-15 and 06-30-16 Date of Report: 08-06-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 9718 FSPSA's found of which 372 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 2 4 3.142857 $116.2900 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 17 25 187.168654 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 4 25.714285 $951.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 19 33 216.025796 $1067.7200 $4.9400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 6 281.611111 $13658.1400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.111111 $52.3200 $47.0900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.277778 $13.3100 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 43 46 26.823016 $588.7700 $21.9500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.150000 $3.2800 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 2.950000 $192.1600 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.022222 $39.2200 $38.3700
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 13 10.055556 $470.6000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 15 10.741552 $1284.6800 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 4 6 12.388889 $619.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 22 24 61.842242 $3092.1200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 9 9 16.561113 $1242.1000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 37 47 116.750000 $8756.2500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 119 182 840.020106 $63001.5500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 12.055556 $904.1700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 97 205 317.180208 $23788.4900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 123 168 256.801061 $14252.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 0.027778 $2.0900 $75.0600
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 20 20.138812 $1510.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 4.011111 $300.8300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 109 112 198.910651 $11039.5400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 71 78 109.750389 $8231.2900 $75.0000
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 17 20 9.779223 $1466.8700 $150.0000
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 0.733333 $37.4400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 12.466667 $636.4300 $51.0500
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Subtotal (Total Children Is Unduplicated) 473 974 2325.337263 $155193.0600 $66.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 27 80.126940 $400634.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 2.238888 $111.9400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 111 116 110.169220 $5508.4500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 9.326984 $667.9000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 18 18 8.504546 $2034.3200 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 137 189 746.455373 $37322.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 11 5.055557 $126.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 414 778 1800.687213 $90034.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 47 64 132.211111 $3305.2800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 22 28 85.411110 $6262.3300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 51 70 561.571432 $14039.2900 $25.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 36 36 65.700000 $3285.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1185 2874 26542.676330 $1327134.3500 $50.0000
INTR -T1013 INTERPRETER 1 1 8.000000 $400.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 954 2390 19696.734895 $196967.3900 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 3.238890 $210.5400 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 6 7.938888 $1882.4500 $237.1200
SENS -V5264 EARMOLD 10 17 21.344444 $384.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 6 26.857143 $1918.6800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.000000 $27.7600 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 678 2052 11617.673427 $5808.8300 $0.5000
TRAV -TRAVS Travel by mile 12 16 4706.818875 $2094.5300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1251 8711 66240.741266 $2100161.3200 $31.7000
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Total 9718 68782.104325 $2256422.1000 $32.8100
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Number of Children (Unduplicated) With at Least One Authorization 1260