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: 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 1420 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 33 39.906348 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 33 39.906348 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 18 22 18.561111 $900.2100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.061111 $3.7700 $61.7000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 2.061111 $31.3100 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 74 79 47.527786 $1154.0000 $24.2800
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
EXIT -EXIT COS Exit 3 3 4.000000 $200.0000 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.600000 $209.2000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 12.195238 $708.6700 $58.1100
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Subtotal (Total Children Is Unduplicated) 97 113 89.006357 $3262.0500 $36.6500
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.355556 $64.9900 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 20 28 24.583333 $122916.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 4 5 3.594444 $832.5300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 11 14 7.642857 $382.1500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 6 6 4.285714 $214.2900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.033333 $75.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 7 14.940476 $747.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 50 53 111.003174 $5550.1500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 58 90.248410 $4512.4100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 74 85 172.380949 $8619.0400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 4.200000 $210.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 5.116666 $127.9200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 360 443 2797.874615 $151085.2300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 35 40 193.014286 $10422.7800 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 130 178 1154.649208 $13855.8000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 52 380.923810 $30976.7500 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 26.000000 $2114.3200 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 60 71 523.471435 $42568.7000 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 21.704763 $1765.0300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 22 31 218.361905 $17757.2000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 19.066667 $1550.5000 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 30 35 243.144445 $19772.4900 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 30.333333 $2466.7000 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 47 57 350.052383 $28466.2600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.033333 $246.6700 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 76 86 494.558734 $40217.5300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 32.128572 $2612.7100 $81.3200
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Subtotal (Total Children Is Unduplicated) 660 1274 6930.702401 $510131.4900 $73.6000
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Total 1420 7059.615106 $513393.5400 $72.7200
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Number of Children (Unduplicated) With at Least One Authorization 679