Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 2708 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 16 16 13.858730 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 16 13.858730 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 3 3 3.111111 $363.4700 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 1 2 0.511111 $59.7100 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 167 217 207.016666 $10040.3100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 26 28 25.877777 $1596.9100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 3.316666 $50.3800 $15.1900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.177778 $4.6300 $26.0400
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 57 61 51.688888 $1255.0000 $24.2800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.255556 $2.7800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $31.8100 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $23.1400 $23.1400
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 2 0.511111 $31.0400 $60.7300
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.166667 $13.0400 $78.2700
AUDE -V5010 ASSESSMENT FOR HEARING AID 39 40 17.227775 $780.7500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 2.177777 $252.2000 $115.8100
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Subtotal (Total Children Is Unduplicated) 273 366 314.038883 $14505.1800 $46.1900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 9 10 5.205555 $249.5500 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 2 2 0.561111 $26.9000 $47.9400
AACFIT-92609TLGT AAC FITTING, ADJUST, TRAINING VISIT 1 2 1.022222 $49.0000 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 68 85 124.485713 $622428.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 230 280 201.987697 $10099.3800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 15 17 19.178571 $958.9300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 77 100 99.994443 $4999.7100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.005556 $0.2800 $50.4000
CONIP -CONIP CONSULT, ITDS PHONE 1 2 1.155556 $28.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 192 223 343.898409 $17194.8500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 6.563492 $328.1800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.800000 $45.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 102 126 145.748408 $7287.3800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.777778 $38.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 248 314 406.614286 $20330.6300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 9 6.022221 $150.5500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 21 114.185713 $3083.0100 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 545 727 4395.277808 $237345.1000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 25 30 235.928573 $12740.1600 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9 9 17.811111 $213.7300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 66 89 477.149208 $38801.8200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 0.428571 $34.8500 $81.3300
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 11.571429 $940.9900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.000000 $65.1200 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 63 75 444.180952 $36120.8100 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 1 1 2.000000 $162.6400 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 5 5 13.500001 $879.1100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 31 37 192.504763 $15654.5000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 13.142857 $1068.7800 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 44 58 337.971434 $27483.8400 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.022222 $234.7100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.022222 $469.4100 $459.2100
SENS -V5264 EARMOLD 4 5 6.258730 $113.4700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 47 60 375.912702 $30569.2500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 17 20 102.171430 $8308.5900 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 15.942858 $1296.4700 $81.3200
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Subtotal (Total Children Is Unduplicated) 824 2326 8124.003602 $1099802.5000 $135.3800
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Total 2708 8451.901215 $1114307.6800 $131.8400
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Number of Children (Unduplicated) With at Least One Authorization 833