Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2460 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 74 87 88.657142 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 74 87 88.657142 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 3.000000 $185.1300 $61.7100
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 7.000000 $810.6700 $115.8100
EXIT -EXIT COS Exit 81 81 81.000000 $4050.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
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Subtotal (Total Children Is Unduplicated) 87 89 95.000000 $5285.4800 $55.6400
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 24 33 70.006348 $4854.9400 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 83 86 83.891158 $4194.5600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 39 39 29.470597 $1473.5300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 33 34 32.910914 $822.7800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 6 6.461111 $323.0600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 4 15.500000 $775.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 10.428571 $260.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 4.211111 $210.5600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 6.500000 $325.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.033333 $101.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.000000 $75.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 1.666666 $83.3300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 3.000000 $150.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 17 23 767.428568 $19185.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 651 851 6763.061964 $365204.9300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 51 59 464.657144 $25091.4700 $54.0000
INTR -T1013 INTERPRETER 81 119 686.157143 $34307.8800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 666 901 7101.300062 $85215.5100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 13 82.414286 $6701.9200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.142857 $269.7900 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 3.857142 $251.1800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 17 21 163.107144 $13263.8800 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 5 28.514285 $2318.7900 $81.3200
PHY -97110HM PT SESSION BY PT ASST 6 7 57.285714 $3730.4400 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 5 7 40.857143 $2660.6100 $65.1200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 2 4.000000 $459.2400 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.000000 $688.8300 $229.6100
SENS -V5264 EARMOLD 13 18 29.501587 $534.8600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 24 152.214287 $12378.0700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 56.714286 $4612.0000 $81.3200
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Subtotal (Total Children Is Unduplicated) 784 2284 16679.293421 $590619.5900 $35.4100
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Total 2460 16862.950563 $595905.0700 $35.3400
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Number of Children (Unduplicated) With at Least One Authorization 845