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: 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 1397 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 19 22 23.104762 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 22 23.104762 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 92 117 99.473810 $4824.4800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 7 8.000000 $493.6800 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.566667 $62.3200 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 2.577778 $116.8300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
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Subtotal (Total Children Is Unduplicated) 100 132 113.618255 $5613.1100 $49.4000
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.555556 $122.5200 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 35 38 52.222223 $261111.5000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 12.857143 $891.6400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 229 274 234.511507 $11725.5700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 11 13 11.322222 $566.1100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 95 128 150.352376 $7517.6000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.500000 $25.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 177 202 236.907938 $11845.4100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 2.433333 $60.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 112 139 156.382543 $7819.1400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 251 310 331.655548 $16582.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 14 6.900000 $172.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 52 68 374.779366 $20238.0600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 7 41.500000 $2241.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 54.071429 $4397.0900 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530TL OT SESSION BY LICENSED OT 5 5 21.149207 $1719.8500 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 1 2 8.071428 $525.6100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 5 8 26.123810 $2124.3900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 12.857143 $1045.5400 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 12 80.200001 $6521.8500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 2.500000 $203.3000 $81.3200
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Subtotal (Total Children Is Unduplicated) 549 1243 1836.781345 $359286.9500 $195.6100
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Total 1397 1973.504362 $364900.0600 $184.9000
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Number of Children (Unduplicated) With at Least One Authorization 572