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: 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 1588 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 71 80 81.907136 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 71 80 81.907136 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EXIT -EXIT COS Exit 103 103 102.142857 $5107.1500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 105 106 107.142857 $5492.8000 $51.2700
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 3.011111 $208.8200 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 77 77 68.673140 $3433.6600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 43 44 34.110384 $1705.5200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 24 24 16.194408 $404.8600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 9 14.999999 $750.0000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 4 4.800000 $240.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 5.704762 $142.6200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 5 8.733333 $436.6700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 7.100000 $355.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 5 3.233334 $161.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.033333 $75.8300 $25.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 3 5.333333 $266.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.600000 $15.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 54 72 511.352381 $27613.0400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 4 9.285715 $501.4300 $54.0000
INTR -T1013 INTERPRETER 96 146 685.811904 $34290.6000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 718 989 7558.385734 $90700.6300 $12.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 2 2 3.011111 $54.5900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 5 34.642857 $2817.1500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.857143 $394.9800 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 775 1402 8983.873982 $164798.3300 $18.3400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1588 9172.923975 $170291.1200 $18.5600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 835