Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 7449 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 6 6 2.311112 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 2.311112 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $30.3800 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 649 677 677.000000 $14528.4200 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 598 620 620.000000 $10013.0000 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 592 614 614.000000 $4862.8800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 591 613 613.000000 $19499.5300 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $15.1900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 591 613 612.122222 $14164.5100 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 12 13 20.822222 $1041.1100 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 60 72 77.420635 $4498.9200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 18 18 17.888889 $1039.5200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 77 92 91.388889 $5310.6100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 763 3338 3349.642857 $75223.3100 $22.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 18 20.428571 $102143.0000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 309 428 512.485714 $25624.2900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 58 72 110.549211 $5527.4800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 105 124 126.571427 $6328.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 213 276 359.368259 $17968.4500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.571429 $228.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1200 1701 13760.339680 $743058.8800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 303 422 3043.745260 $247517.3500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 356 519 3031.321454 $246506.9100 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 384 541 3309.767471 $269150.3100 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 6.285714 $511.1500 $81.3200
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Subtotal (Total Children Is Unduplicated) 1640 4105 24287.434190 $1664812.7000 $68.5500
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Total 7449 27639.388159 $1740036.0100 $62.9500
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Number of Children (Unduplicated) With at Least One Authorization 1672