Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 2975 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 96 106 153.377780 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 96 106 153.377780 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 3.000000 $347.4300 $115.8100
EXIT -EXIT COS Exit 109 111 89.250000 $4462.5000 $50.0000
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Subtotal (Total Children Is Unduplicated) 111 113 92.250000 $4809.9300 $52.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 27 31 88.433335 $6132.8800 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.388889 $96.3200 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 96 101 101.426115 $5071.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 37 39 32.453350 $1622.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 47 48 25.036075 $625.9100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 14 18.655557 $932.7900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 2.266667 $113.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 10 17.521429 $438.0400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 7 7.622222 $381.1100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 3.155556 $157.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.483334 $162.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 4 3.833334 $191.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 4 9.166666 $229.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 4 4.333333 $216.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 7.133334 $178.3400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 33 42 906.571438 $22664.2700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 52.571428 $1419.4300 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 756 1019 7919.652384 $427661.6900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 59 66 465.676190 $25146.5700 $54.0000
INTR -T1013 INTERPRETER 51 73 612.614283 $30630.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 786 1100 8514.142859 $102169.8300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 19 135.200001 $10994.4600 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 1.000000 $81.3200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 4 5 45.571428 $2967.6200 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 4 26.285714 $1711.7200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 29 37 226.241268 $18397.9700 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 7 9 31.450001 $2557.5100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 11 16 121.878572 $7936.7400 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 6 7 57.285714 $3730.4500 $65.1200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 2.000000 $229.6200 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 14 15 64.182540 $1163.6300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 33 43 303.535714 $24683.5400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 11 15 120.749999 $9819.4100 $81.3200
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Subtotal (Total Children Is Unduplicated) 898 2756 19937.518729 $715746.1300 $35.9000
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Total 2975 20183.146509 $720556.0600 $35.7000
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Number of Children (Unduplicated) With at Least One Authorization 967