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: 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 6445 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 4 4 2.077779 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.077779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.1900 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 627 658 658.000000 $14120.6800 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 614 645 645.000000 $10416.7500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 615 644 644.000000 $5100.4800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 613 642 642.000000 $20422.0200 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.000000 $30.3800 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 608 636 636.000000 $14717.0400 $23.1400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 9 17.866667 $893.3400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 32 33 33.000000 $1917.6300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 13 14 13.211111 $767.7000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 47 57 58.142857 $3378.6800 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 6 65.142857 $3785.4500 $58.1100
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Subtotal (Total Children Is Unduplicated) 687 3351 3419.363492 $75797.7700 $22.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 14 14.000000 $70000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 227 279 439.217460 $21960.8600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 43 52 75.100002 $3755.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 58 61.788891 $3089.4600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 153 179 266.522223 $13326.1200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1075 1469 12558.722681 $678170.5500 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 213 263 2243.857137 $182470.3700 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 301 392 2606.483317 $211959.2900 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 284 378 2616.178560 $212747.5900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 6 6 23.825397 $1937.4700 $81.3200
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Subtotal (Total Children Is Unduplicated) 1373 3090 20905.695668 $1399416.7100 $66.9400
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Total 6445 24327.136939 $1475214.4900 $60.6400
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Number of Children (Unduplicated) With at Least One Authorization 1394