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 6002 FSPSA's found of which 287 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
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Subtotal (Total Children Is Unduplicated) 18 29 190.311511 $116.2900 $0.6100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 6 281.611111 $13658.1400 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.277778 $13.3100 $10.4200
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 5 3.222222 $150.8000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 6 3.447108 $412.2700 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 4 10.000000 $500.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 21 22 58.842242 $2942.1200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 9 4.477778 $335.8400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 38 44 28.469844 $2135.2600 $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 28 39 16.761032 $1257.0600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 28 31 14.705557 $816.1700 $55.5000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 4 4.133334 $310.0100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.500000 $582.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 6 5.055556 $379.1700 $75.0000
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 11 14 5.282876 $792.4200 $150.0000
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) 118 198 460.741994 $24958.4000 $54.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 10 69.269406 $346346.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 2.238888 $111.9400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 99 104 98.408902 $4920.4400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 8.676984 $621.3500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 3.150001 $753.5000 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 134 186 742.955373 $37147.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 11 5.055557 $126.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 414 773 1782.553880 $89127.7500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 47 64 132.211111 $3305.2800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 12 35.992063 $2638.9300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 13 68.014287 $1700.3600 $25.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 2.000000 $100.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 115 164 1115.614177 $55780.7600 $50.0000
INTR -T1013 INTERPRETER 1 1 8.000000 $400.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 954 2382 19642.538071 $196425.4200 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.705556 $45.8600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.044444 $484.7700 $237.1100
SENS -V5264 EARMOLD 3 5 9.883333 $177.9000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 2 7.071429 $505.1800 $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 673 2017 11405.490886 $5702.7400 $0.5000
TRAV -TRAVS Travel by mile 12 16 4706.818875 $2094.5300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1232 5775 39850.693223 $748545.1400 $18.7800
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Total 6002 40501.746728 $773619.8300 $19.1000
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Number of Children (Unduplicated) With at Least One Authorization 1235