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 565 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 31 84.006349 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 31 84.006349 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.466667 $12.1500 $26.0400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.466667 $10.8000 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.466667 $36.5200 $78.2600
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.066667 $53.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 44.747619 $2237.3800 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 5 27.571429 $1602.1700 $58.1100
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Subtotal (Total Children Is Unduplicated) 12 15 74.785716 $3952.3600 $52.8500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 61 91 128.500000 $6425.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 12.000000 $300.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 93 105 119.411112 $5970.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 45 49 58.911110 $2945.5500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 25 36.311111 $1815.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 60 64 64.755556 $3237.7800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 94 108 856.057145 $46227.0700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 19 134.214285 $10914.3100 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 9.142858 $595.3800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 16 22 180.030951 $14640.1400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 24 185.214285 $15061.6200 $81.3200
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Subtotal (Total Children Is Unduplicated) 246 519 1784.548413 $108132.9500 $60.5900
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Total 565 1943.340478 $112085.3200 $57.6800
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Number of Children (Unduplicated) With at Least One Authorization 280