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: 04-01-24 and 06-30-24 Date of Report: 04-12-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1605 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 42 43 53.023810 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.033333 $38.4400 $37.2000
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Subtotal (Total Children Is Unduplicated) 43 44 54.057143 $38.4400 $0.7100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 23 19.244446 $933.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 1.794445 $110.7400 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 1.966667 $29.8700 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 94 99 60.472231 $1468.2900 $24.2800
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
EXIT -EXIT COS Exit 2 2 2.000000 $100.0000 $50.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $89.8800 $59.9200
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 23.780953 $1381.9100 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 20.495239 $1190.9800 $58.1100
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Subtotal (Total Children Is Unduplicated) 123 137 132.253981 $5359.9300 $40.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 33 30.183336 $150918.0000 $5000.0400
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 3.716667 $860.8600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 26 16.500000 $825.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.700000 $67.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 10.783333 $539.1700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 65 73 146.473806 $7323.6800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.883334 $172.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 73 84 128.684922 $6434.2600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 88 102 183.003179 $9150.1700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.133333 $56.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 12 14.811112 $370.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 421 519 3319.200018 $179236.7600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 30 32 194.900003 $10524.6100 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 106 139 845.327784 $10143.9300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 55 325.761906 $26490.9700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 15.714286 $1277.8900 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 68 83 540.911909 $43986.9800 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 15.600000 $1268.5900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 32 36 247.395238 $20118.1700 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.200000 $178.9000 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 28 37 213.909526 $17395.1000 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 3 15.714286 $1277.8900 $81.3200
SENS -V5264 EARMOLD 2 2 1.088889 $19.7400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 51 60 344.971431 $28053.1000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 4 24.776191 $2014.7900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 73 93 519.504764 $42246.1100 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 29.047619 $2362.1500 $81.3200
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Subtotal (Total Children Is Unduplicated) 723 1424 7201.896872 $563363.3400 $78.2200
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Total 1605 7388.207996 $568761.7100 $76.9800
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Number of Children (Unduplicated) With at Least One Authorization 757