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 1488 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
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 167 217 207.016666 $10040.3100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 6.261111 $386.3700 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.511111 $7.7600 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 3.105555 $75.4000 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.700000 $31.7200 $45.3200
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Subtotal (Total Children Is Unduplicated) 175 230 217.594443 $10541.5700 $48.4500
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.477778 $22.9100 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 47 59 88.966666 $444833.0000 $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 3 3 8.357143 $225.6400 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 48 56 325.707938 $17588.2300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 32.000000 $1728.0100 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9 9 17.811111 $213.7300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 12 67.161906 $5461.6100 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 6.000000 $487.9200 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 2.571429 $209.1100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 3 3 16.509523 $1342.5500 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.500000 $528.5800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 14 84.280955 $6853.7200 $81.3200
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Subtotal (Total Children Is Unduplicated) 541 1242 1890.090866 $540957.6800 $286.2100
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Total 1488 2121.544039 $551499.2500 $259.9500
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Number of Children (Unduplicated) With at Least One Authorization 567