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: 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 2814 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 31 33 87.239683 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 31 33 87.239683 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 2 1.011111 $21.7000 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 1.011111 $26.3300 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 1.011111 $16.3300 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 2 1.011111 $8.0100 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 2 1.011111 $32.1600 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 2 1.011111 $23.4000 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 2 1.011111 $79.1200 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 1.011111 $45.8200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 1.011111 $117.1000 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 32.209525 $1610.4800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 19 21 140.219045 $7010.9600 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 19 143.428571 $8334.6400 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 38 64 325.957140 $17384.1400 $53.3300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 150 213 264.127020 $13206.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 74 100 98.546960 $2463.6800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 180 210 204.611112 $10230.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 96 104 107.338887 $5366.9400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 61 66 69.399999 $3470.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 118 129 122.999998 $6149.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.311111 $7.7800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1059 1476 11686.838124 $631089.1900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 92 121 830.748418 $67556.4300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 8 10 52.714287 $3432.7500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 77 118 869.040475 $70670.4000 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.011111 $232.1600 $229.6100
SENS -V5264 EARMOLD 1 2 1.011111 $18.3300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 122 165 1281.730159 $104230.3100 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1135 2717 15590.428772 $918124.8600 $58.8900
-------------------------------------------------------------------------------------------------------------------------------------
Total 2814 16003.625595 $935509.0000 $58.4600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1159