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: 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 1701 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 29 29 53.494445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 29 53.494445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 17 19 16.022221 $777.0700 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.8400 $15.8400
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 82 84 49.594443 $1094.5500 $22.0700
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 15.514285 $797.5900 $51.4100
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Subtotal (Total Children Is Unduplicated) 101 108 83.130949 $2736.4600 $32.9200
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 2.044444 $86.7000 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 17 26 21.944444 $109722.0000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $694.8600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 10 11.628571 $581.4300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 2 1.400000 $35.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 13 23.078572 $1153.9400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 63 75 129.822223 $6491.1200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 2.461111 $123.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 50 79.619045 $3980.9400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 61 74 83.699996 $4184.9900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.133333 $106.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.866667 $146.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 390 465 2536.107933 $126805.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 31 37 236.533332 $11826.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 325 434 1946.194449 $23354.3200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 61 391.347621 $28161.3700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 53 64 343.990477 $24753.5700 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 5 5 25.609523 $1842.8600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 20 24 196.133335 $14113.7400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 5 28.785715 $2071.4200 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 31 44 276.382541 $19888.5100 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 27.704762 $1993.6300 $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 49 60 335.033334 $24109.0000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 3 3.000000 $215.8800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 69 85 461.168255 $33185.6600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 13.661904 $983.1100 $71.9600
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Subtotal (Total Children Is Unduplicated) 665 1564 7218.803968 $442567.3400 $61.3100
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Total 1701 7355.429362 $445303.8000 $60.5400
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Number of Children (Unduplicated) With at Least One Authorization 690