Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1327 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 94 98 70.598406 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 94 98 70.598406 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 11 10.511111 $509.7900 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 7 5.672222 $180.4300 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.100000 $11.5800 $115.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.122222 $7.1000 $58.1000
OCTH -97167 OT EVAL HIGH COMPLEXITY 40 51 26.055556 $1514.0900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 2.177778 $126.5500 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 47 54 28.238887 $1640.9500 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.127778 $7.4300 $58.1200
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 52 65 37.694446 $2190.4300 $58.1100
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Subtotal (Total Children Is Unduplicated) 141 195 111.700000 $6246.4700 $55.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 14 10.477778 $52389.0000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 16 25.066668 $1253.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 57 72 104.311114 $5215.5700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 45 51 87.144445 $4357.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 78 97 147.099996 $7354.9800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 386 569 3142.979339 $169721.1100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 25.000000 $1350.0100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 41 61 335.485711 $27281.7200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 52 70 345.903966 $28128.9200 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.024658 $5.6700 $230.0000
SENS -V5264 EARMOLD 1 1 0.024658 $0.4500 $18.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 54 79 383.074601 $31151.6300 $81.3200
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Subtotal (Total Children Is Unduplicated) 524 1034 4606.592934 $328209.6200 $71.2500
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Total 1327 4788.891340 $334456.0900 $69.8400
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Number of Children (Unduplicated) With at Least One Authorization 609