Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 1857 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 14 14 13.577778 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.733333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 15 14.311111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 132 167 146.528568 $7106.6200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.388889 $21.8200 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 1.511111 $23.9400 $15.8400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.511111 $12.1000 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 0.511111 $7.5000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 3 2.511111 $55.4200 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 2 0.511111 $4.5000 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 3 1.511111 $43.7000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 3 1.511111 $68.1200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 2 0.511111 $7.0600 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 2 0.511111 $10.7500 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.511111 $44.4400 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 3.511111 $159.1200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.511111 $59.1900 $115.8100
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Subtotal (Total Children Is Unduplicated) 137 197 161.050789 $7624.2800 $47.3400
EI Services, Class # 03
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.011111 $42.8800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 24 28 40.794443 $203971.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 202 262 176.447621 $8822.4000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 6 6 3.983333 $199.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 66 79 73.551586 $3677.5700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 135 149 253.439675 $12671.9500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 5.077777 $253.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 -0.505556 $-12.6400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 108 128 116.907132 $5845.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 228 280 215.553151 $10777.5500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 0.022222 $1.1100 $49.9500
CONSP -CONSP CONSULT, SLP, PHONE 7 8 5.250001 $131.2500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.555556 $38.8900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 11.600000 $580.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 40 196.406349 $9820.3200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 6.133333 $306.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 327 629 2078.568235 $24942.8200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 38.123810 $2743.4000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 9.600000 $690.8200 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 2 3 4.955556 $356.6000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 1 2.300000 $165.5100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 7.733333 $556.4900 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.511111 $234.7100 $459.2100
SENS -V5264 EARMOLD 1 2 0.511111 $9.2700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 23.761904 $1709.9100 $71.9600
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Subtotal (Total Children Is Unduplicated) 570 1645 3274.292794 $288562.3000 $88.1300
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Total 1857 3449.654694 $296186.5800 $85.8600
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Number of Children (Unduplicated) With at Least One Authorization 590