Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 2462 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 23 23 20.855555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 23 20.855555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 8 8 6.177778 $721.7500 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 6 6 5.316667 $621.1500 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 71 85 67.337306 $3265.8800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 12 8.477777 $523.1600 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.1900 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $21.4600 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $26.0400 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 3.061111 $49.4400 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 42 47 36.261116 $880.4300 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 2.000000 $15.8400 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 2.072222 $65.9200 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 3.000000 $148.7700 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.000000 $30.3800 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 2.000000 $46.2800 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 33 38 14.872228 $674.0400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.400000 $162.1300 $115.8100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 6.816667 $396.1200 $58.1100
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Subtotal (Total Children Is Unduplicated) 159 221 163.792872 $7663.9800 $46.7900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 12 13 9.055557 $434.1300 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 6 7 5.377778 $257.8100 $47.9400
AACFIT-92609TLGT AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.633333 $30.3600 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 37 45 59.616665 $298082.5000 $4999.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.285714 $227.8600 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 202 249 230.234926 $11511.7700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 17 19 18.411111 $920.5600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 60 72 74.841269 $3742.0700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.272222 $13.6100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 121 121 114.370634 $5718.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.433333 $35.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 87 89 106.146825 $5307.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 186 199 198.794445 $9939.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 4.716666 $117.9200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 45.485714 $1228.1200 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 580 773 4558.776193 $246173.8700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 54 63 368.574602 $19903.0300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 62 68 303.646033 $24692.4600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 6 7 40.285715 $3276.0300 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 6.500000 $528.5800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 10 13 80.919047 $5269.4500 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 10.857143 $707.0100 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 67 76 378.362701 $30768.4600 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 24 29 157.546030 $12811.6700 $81.3200
OCCT -97530TLGOGT OT SESSION BY LICENSED OT 1 1 1.011111 $82.2200 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 2.133333 $173.4800 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 14 19 76.452382 $4978.5800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 49 56 209.565871 $17041.8900 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 0.714286 $58.0900 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 4 5 15.147618 $1231.8000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 6 38.857142 $3159.8700 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 45 53 266.407937 $21664.2900 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 2.857143 $232.3400 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.142857 $418.2100 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 1.400000 $642.9100 $459.2200
SENS -V5264 EARMOLD 3 4 2.800000 $50.7600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 84 99 402.661904 $32744.4500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 14 15 58.469843 $4754.7700 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 68 80 190.687302 $15506.6800 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 18.080952 $1470.3500 $81.3200
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Subtotal (Total Children Is Unduplicated) 860 2218 8072.533337 $786210.3400 $97.3900
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Total 2462 8257.181764 $793874.3100 $96.1400
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Number of Children (Unduplicated) With at Least One Authorization 879