Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1364 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 8 8 12.863491 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 8 8 12.863491 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 41 47 39.423636 $1912.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.377778 $85.0200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.283333 $4.3000 $15.1900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.377778 $43.7500 $115.8200
EXIT -EXIT COS Exit 2 2 1.002740 $50.1400 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.005479 $0.4500 $81.2900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3300 $60.1600
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 3 6.000000 $485.8800 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $323.9200 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 2.283333 $132.6800 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 2 0.505555 $29.3700 $58.1000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.283333 $74.5700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 2 0.505555 $29.3700 $58.1000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 49 73 64.053999 $3631.5900 $56.7000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.086074 $5430.5000 $5000.1200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 65 100.372153 $5018.5800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 8 9 11.933333 $596.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 328 446 877.804726 $43890.0500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 5 8 15.599999 $780.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.333333 $58.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 211 250 510.209502 $25510.3600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 9 4.766665 $238.3300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 2 3.000000 $150.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 6.099999 $152.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 305 363 726.299969 $36314.8400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 2 3.000000 $150.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 6.300000 $157.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 16 94.857142 $5122.2900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 32.857143 $1774.2800 $54.0000
INTR -T1013 INTERPRETER 22 35 76.250000 $3812.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 11 16 62.780952 $753.3700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 6 46.285714 $3763.9500 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.377778 $86.7500 $229.6200
SENS -V5264 EARMOLD 1 1 1.133333 $20.5500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 5 36.857143 $2997.2200 $81.3200
TRAV -TRAVS Travel by mile 18 34 2110.528569 $939.1900 $0.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 395 1283 4730.733527 $137717.7300 $29.1100
-------------------------------------------------------------------------------------------------------------------------------------
Total 1364 4807.651017 $141349.3200 $29.4000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 419