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: 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 7763 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 10 11 6.716668 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 11 6.716668 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $30.3800 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 811 841 858.743248 $18428.6300 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 805 833 850.743248 $13739.5000 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 805 833 850.743248 $6737.8900 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 801 829 846.743248 $26934.9000 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.000000 $30.3800 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 794 822 839.743248 $19431.6600 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.000000 $81.2400 $81.2400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 11 13.722222 $686.1100 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 34 35 32.911111 $1912.4600 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 4.000000 $232.4400 $58.1100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 11 14 15.000000 $871.6500 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 56 59 58.322222 $3389.1000 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 9 9.000000 $522.9900 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 23 29 300.738095 $17475.9000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 3 32.285715 $1876.1200 $58.1100
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Subtotal (Total Children Is Unduplicated) 894 4334 4724.695605 $112737.6800 $23.8600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 15 15.000000 $75000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 214 309 482.022208 $24101.0400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 55 83.922221 $4196.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 46 54 52.744440 $2637.2000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 139 171 254.277768 $12713.8400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1191 1691 13847.879376 $747785.5100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 7.571429 $408.8600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 215 286 2241.796430 $182302.8700 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 332 435 2668.285719 $216984.9400 $81.3200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 300 397 2863.076194 $232825.3600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 7.785714 $633.1400 $81.3200
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Subtotal (Total Children Is Unduplicated) 1532 3418 22525.361499 $1499607.0000 $66.5700
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Total 7763 27256.773772 $1612344.6800 $59.1500
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Number of Children (Unduplicated) With at Least One Authorization 1558