Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2782 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 39 42 100.455558 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 39 42 100.455558 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.033333 $0.6500 $19.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.033333 $0.7900 $23.6500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.033333 $0.4900 $14.6600
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.033333 $0.2900 $8.8000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.033333 $0.9600 $28.8900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.033333 $0.7000 $21.0200
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.033333 $2.9000 $86.8500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.033333 $1.5100 $45.2800
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.033333 $3.8600 $115.7000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 13.000001 $650.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 17 93.414285 $4670.7300 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 18 21 191.285713 $9834.0100 $51.4100
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Subtotal (Total Children Is Unduplicated) 36 51 298.999996 $15218.2900 $50.9000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 136 200 245.098079 $12254.9200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 97 134 136.824379 $3420.6100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 167 186 186.536508 $9326.8200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 89 95 109.353174 $5467.6500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 63 67.960316 $3398.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 100 107 114.260318 $5713.0200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.094444 $2.3600 $24.9900
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1096 1501 12167.633345 $608382.0800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 96 121 887.088891 $63834.9300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 82 101 919.858728 $66193.1100 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.033333 $3.8200 $114.7000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.033333 $7.6500 $229.3800
SENS -V5264 EARMOLD 1 1 0.033333 $0.6000 $18.1100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 143 176 1414.485717 $101786.4800 $71.9600
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Subtotal (Total Children Is Unduplicated) 1194 2689 16262.436755 $880449.1800 $54.1400
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Total 2782 16661.892309 $895667.4700 $53.7600
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Number of Children (Unduplicated) With at Least One Authorization 1226