Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 4323 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 41 45 48.162698 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 45 48.162698 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 2.000000 $97.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 32 34 33.522222 $2068.6600 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 25 27 21.461110 $325.9900 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 55 59 51.221427 $1099.2100 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $26.0400 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $32.3000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 4.866667 $118.1600 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 19 19 19.225614 $611.5600 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 80 93 63.588884 $965.9100 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 36 39 58.657142 $1357.3200 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 2.566667 $116.3200 $45.3200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 9.142857 $547.8400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 7.142857 $578.4300 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 16 23 22.111111 $1284.8800 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 50 58 41.061110 $2386.0500 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 0.472222 $27.4400 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 7.622222 $442.9300 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 3.511111 $204.0300 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 41 48 39.461110 $2293.0800 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 1.433333 $83.2900 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 1.322222 $76.8300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 17 21 16.905555 $982.3800 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 22 31 15.849997 $921.0300 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.511111 $87.8100 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 14 8.644444 $502.3300 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 0.761111 $44.2300 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 1.322222 $76.8300 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 68 77 53.283334 $3096.3000 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 9 10 15.244445 $885.8600 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $116.2200 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 2.000000 $116.2200 $58.1100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 96 108 84.253965 $4895.9800 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 3.422222 $198.8600 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.500000 $87.1700 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 4 6 3.588889 $208.5500 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 4.466667 $259.5600 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 8 9 102.714286 $5968.7400 $58.1100
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Subtotal (Total Children Is Unduplicated) 507 743 717.858136 $33643.8500 $46.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 3.000000 $15000.0000 $5000.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.822222 $126.3700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 12 13 25.566667 $5921.7600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 152 182 160.647633 $8032.4400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 7 7 5.750000 $287.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 5.883333 $147.0800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 461 638 1724.193667 $86209.7600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 5 6 25.333333 $1266.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 6.133333 $153.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 244 309 747.766678 $37388.3900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 6 10.133334 $506.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.833333 $20.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 94 117 317.804765 $15890.2600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 261 342 727.355573 $36367.8700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 7 7 16.900001 $845.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.366667 $34.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1063 1413 13204.409483 $713038.7700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 58 67 663.582536 $35833.4800 $54.0000
INTR -T1013 INTERPRETER 2 2 11.857143 $592.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 95 120 1139.638094 $92675.4300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 8.285714 $539.5700 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 56 75 674.914287 $54884.0900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 2 13.142857 $1068.7700 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 2.566667 $2517.2700 $980.7500
SENS -V5264 EARMOLD 2 2 5.393651 $97.7900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 145 187 1467.200000 $119312.8500 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 17 19 222.552380 $14492.6100 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 63.428571 $4130.4600 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $1068.7800 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 3.000000 $195.3600 $65.1200
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Subtotal (Total Children Is Unduplicated) 1170 3535 21288.747636 $1250174.1900 $58.7200
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Total 4323 22054.768470 $1283818.0400 $58.2100
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Number of Children (Unduplicated) With at Least One Authorization 1205