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 1402 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 34 37 37.000000 $794.0200 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 26 29 29.000000 $468.3500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 26 29 29.000000 $229.6800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 26 29 29.000000 $922.4900 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 26 29 29.000000 $671.0600 $23.1400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 12 13 20.822222 $1041.1100 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 7 8 8.000000 $464.8800 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 9.000000 $522.9900 $58.1100
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Subtotal (Total Children Is Unduplicated) 59 183 190.822222 $5114.5800 $26.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
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 147 180 1455.549209 $78599.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 39 233.714287 $19005.6200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 31 40 250.114286 $20339.2800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 48 52 345.371428 $28085.6000 $81.3200
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Subtotal (Total Children Is Unduplicated) 524 1213 3399.295250 $206707.5600 $60.8100
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Total 1402 3592.428584 $211822.1400 $58.9600
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Number of Children (Unduplicated) With at Least One Authorization 538