Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-24 and 03-31-24 Date of Report: 04-04-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3740 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 2 2 0.544445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 0.544445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 47 55 36.886456 $1789.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 2.995434 $184.8500 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.011111 $15.3600 $15.1900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.238356 $3.8500 $16.1500
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 0.244444 $19.8600 $81.2300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.128767 $5.8400 $45.3300
EXIT -EXIT COS Exit 2 2 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 50 52 82.454790 $6677.2100 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 13 14 27.500000 $2226.9500 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 46.000000 $3725.0800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 10 19.000000 $1538.6200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 56 58 96.054790 $5755.6200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 18 19 37.500000 $2247.0000 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 36 52 99.000000 $8017.0200 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 7 10 20.000000 $1619.6000 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 0.910578 $52.9100 $58.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 49 56 54.685160 $3177.7500 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 4 6 3.883333 $225.6600 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 15 4.525191 $262.9700 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 26.471233 $1538.2400 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.249315 $14.4900 $58.1100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.057534 $3.3400 $58.0800
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 5 2.610045 $151.6700 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.372222 $21.6300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.460426 $26.7500 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 2 0.249316 $14.4900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 36 44 24.967103 $1450.8400 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 4 4.538888 $263.7500 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 13 14 6.692544 $388.9200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.505556 $87.4900 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 67 74 60.718567 $3528.3500 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 5 3.538889 $205.6500 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 2.224429 $129.2600 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 0.334247 $19.4200 $58.1000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 17 12.727778 $739.6100 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 1.505555 $87.4800 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 0.754871 $43.8700 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.249315 $14.4900 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 26.000000 $1510.8600 $58.1100
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Subtotal (Total Children Is Unduplicated) 270 587 726.246243 $49000.8700 $67.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 45 51 137.742641 $688714.5000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.011111 $70.1200 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.033333 $210.3600 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.011111 $234.1900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 59 60 80.711721 $4035.5500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 6 7 5.104166 $255.2100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 4.266666 $106.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 319 451 885.066639 $44253.2000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 3 4.600000 $230.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 199 243 462.063582 $23103.0900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 6.066666 $303.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 6.999999 $175.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 11 27.315982 $1365.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 3 6.066666 $151.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 307 387 821.887274 $41094.2200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.566667 $78.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 9 17.033333 $425.8300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 3 20.285714 $1014.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 303 385 3062.719060 $165386.7500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 47 55 450.438097 $24323.6500 $54.0000
INTR -T1013 INTERPRETER 15 24 95.579648 $4778.9800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 245 550 2609.319036 $31311.8200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 100 118 976.261907 $79389.6000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 68.428572 $5564.6100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 56 69 640.303969 $52069.5100 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 3 26.000000 $2114.3200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 7 8 71.428571 $4651.4300 $65.1200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.011111 $464.3200 $459.2100
SENS -V5264 EARMOLD 1 1 1.011111 $18.3300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 114 129 958.917461 $77979.1300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 11 80.285715 $6528.8300 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 5.142857 $418.2200 $81.3200
TRAV -TRAVS Travel by mile 233 547 138882.095232 $61802.5300 $0.4500
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Subtotal (Total Children Is Unduplicated) 410 3151 150422.775618 $1322673.3600 $8.7900
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Total 3740 151149.566306 $1371674.2200 $9.0700
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Number of Children (Unduplicated) With at Least One Authorization 442