Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 3143 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 38 40 62.736505 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 38 40 62.736505 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.011111 $21.7000 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.011111 $26.3300 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.011111 $16.3300 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.011111 $8.0100 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.011111 $32.1600 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.011111 $23.4000 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.011111 $79.1200 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.011111 $45.8200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.011111 $117.1000 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 18 21 50.676191 $2533.8100 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 20 27 194.710319 $9735.5200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 8.285714 $481.4900 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.142857 $124.5200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 4 13.428571 $780.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 15 22 207.604762 $12063.9100 $58.1100
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Subtotal (Total Children Is Unduplicated) 55 88 486.948413 $26147.6500 $53.7000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 172 280 343.228179 $17161.4000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 64 78 79.182976 $1979.5700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 235 271 259.876551 $12993.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 123 138 135.511907 $6775.6100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 3.588889 $89.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 82 92 92.786454 $4639.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 117 134 125.329016 $6266.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.505556 $112.6400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1179 1591 13001.061917 $702057.4200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 11.000000 $594.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 95 121 801.585721 $65184.9200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 10 16 100.319048 $6532.7800 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $65.1200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 85 113 989.857937 $80495.2700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 3 3 19.142857 $1246.5900 $65.1200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.011111 $232.1600 $229.6100
SENS -V5264 EARMOLD 1 1 1.011111 $18.3300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 125 162 1379.280954 $112163.1300 $81.3200
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Subtotal (Total Children Is Unduplicated) 1256 3015 17352.280184 $1018683.2800 $58.7100
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Total 3143 17901.965102 $1044830.9200 $58.3600
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Number of Children (Unduplicated) With at Least One Authorization 1288