Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 2946 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 31 32 50.982541 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 32 50.982541 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 2 1.022223 $21.9400 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 1.022223 $26.6200 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 1.022223 $16.5100 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 2 1.022223 $8.1000 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 2 1.022223 $32.5200 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 2 1.022223 $23.6600 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 2 1.022223 $80.0000 $78.2600
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 1.022223 $46.3300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 1.022223 $118.3900 $115.8200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 35.923810 $1796.1900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 28 35 214.714285 $10735.7300 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 22 157.000000 $9123.2900 $58.1100
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Subtotal (Total Children Is Unduplicated) 46 79 416.838102 $22029.2700 $52.8500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 141 217 298.446641 $14922.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 63 80 77.994372 $1949.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 200 229 197.631741 $9881.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 117 130 114.994445 $5749.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 70 77 62.905554 $3145.2700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 121 130 118.622219 $5931.1000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1118 1588 12487.271425 $674313.3500 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 94 117 846.717461 $68855.1500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 13 14 92.857144 $6046.8700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 82 115 885.447617 $72004.6800 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.022223 $234.7300 $229.6300
SENS -V5264 EARMOLD 1 2 1.022223 $18.5300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 104 132 1008.483336 $82009.9100 $81.3200
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Subtotal (Total Children Is Unduplicated) 1183 2835 16195.416401 $945113.0700 $58.3600
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Total 2946 16663.237044 $967142.3400 $58.0400
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Number of Children (Unduplicated) With at Least One Authorization 1206