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 996 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 9 10 5.716668 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 10 5.716668 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 30 30 30.000000 $643.8000 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 29 29 29.000000 $468.3500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 29 29 29.000000 $229.6800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 28 28 28.000000 $890.6800 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 28 28 28.000000 $647.9200 $23.1400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 11 13.722222 $686.1100 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.000000 $232.4400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 4 26.166667 $1520.5500 $58.1100
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Subtotal (Total Children Is Unduplicated) 49 166 190.888889 $5493.8600 $28.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 213 307 479.588875 $23979.3800 $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 107 127 1046.388098 $56504.9400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 24 240.964287 $19595.2200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 27 32 201.302382 $16369.9100 $81.3200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 40 48 442.857144 $36013.1400 $81.3200
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Subtotal (Total Children Is Unduplicated) 352 820 2804.045215 $177027.8600 $63.1300
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Total 996 3000.650772 $182521.7200 $60.8300
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Number of Children (Unduplicated) With at Least One Authorization 366