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: 07-01-23 and 09-30-23 Date of Report: 10-10-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1855 FSPSA's found
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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 22 22 25.261112 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 22 25.261112 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 14 12.855555 $623.4900 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.8400 $15.8400
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 74 78 45.022221 $993.6400 $22.0700
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 32.000000 $1645.1100 $51.4100
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Subtotal (Total Children Is Unduplicated) 90 97 91.877776 $3328.0900 $36.2200
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.711111 $114.9800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 10 12 12.377776 $61888.0000 $4999.9300
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 3.133333 $725.7300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 10 21.776189 $1088.8100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 5 5 3.883333 $194.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 5.177779 $258.9000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 1.900000 $95.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 74 84 175.048095 $8752.4000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 5.377778 $268.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.533333 $38.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 41 62.947618 $3147.3800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.666666 $133.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 44 51 86.496822 $4324.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 6.771429 $169.2900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 21.942857 $1097.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 406 495 3117.027762 $155851.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 28 32 174.385713 $8719.2800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 530 702 4231.707102 $50780.5000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 49 57 427.104761 $30734.4800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 8.285714 $596.2400 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 37 41 305.761905 $22002.6400 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 6.600000 $474.9400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 31 40 270.590474 $19471.7000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 29.352381 $2112.2100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 26 30 244.974601 $17628.3900 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.733333 $124.7300 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 43 49 296.866663 $21362.4900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 3.300000 $237.4700 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 38 45 260.099999 $18716.7900 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.611111 $259.8500 $71.9600
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Subtotal (Total Children Is Unduplicated) 628 1736 9798.145638 $431643.0300 $44.0500
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Total 1855 9915.284526 $434971.1100 $43.8700
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Number of Children (Unduplicated) With at Least One Authorization 642