Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1411 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 96 109 77.961897 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 96 109 77.961897 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 9 8.111111 $393.3900 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 4.022222 $127.9500 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.181126 $136.7800 $115.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.900000 $110.4100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 34 40 20.649999 $1199.9700 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 42 60 31.427779 $1826.2800 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 72 85 53.432541 $3104.9700 $58.1100
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Subtotal (Total Children Is Unduplicated) 145 206 123.724778 $7074.0700 $57.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 10 8.622222 $43111.0000 $4999.9900
CONIF -CONIF CONSULT, ITDS FACE TO FACE 18 21 28.033334 $1401.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 55 67 98.555559 $4927.8000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 47 64 83.749999 $4187.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 85 111 137.027783 $6851.4200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 3.266667 $163.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 384 592 3003.407929 $162184.1700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 13.142857 $709.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 52 266.290472 $21654.7400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 48 76 372.599999 $30299.8400 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.410959 $94.3700 $229.6300
SENS -V5264 EARMOLD 2 2 0.410959 $7.4500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 70 96 515.434917 $41915.1700 $81.3200
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Subtotal (Total Children Is Unduplicated) 519 1096 4530.953656 $317508.1700 $70.0800
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Total 1411 4732.640331 $324582.2400 $68.5800
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Number of Children (Unduplicated) With at Least One Authorization 610