Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1303 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 8 8 22.624604 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 22.624604 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 21 26 20.361035 $987.5200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.133333 $8.2300 $61.6900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $16.1500 $16.1500
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.133333 $15.4400 $115.7800
EXIT -EXIT COS Exit 11 11 8.974962 $448.7500 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.511111 $87.8100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.205556 $11.9500 $58.1200
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.511111 $87.8100 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.205556 $11.9500 $58.1200
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Subtotal (Total Children Is Unduplicated) 36 50 42.035997 $2239.1900 $53.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.133333 $5666.5000 $4999.8500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 59 66 112.174663 $5608.7500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 11 12 15.733333 $786.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 338 448 953.019094 $47651.1700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 5 5 8.119048 $405.9600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 189 222 470.961926 $23548.2100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 3.816667 $190.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 8.200001 $205.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 30 59.633337 $2981.6900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 2 3.066667 $153.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 9 11.966668 $299.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 312 367 766.081785 $38304.2900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 3 6.133334 $306.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 16.633335 $415.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11 13 93.000000 $5022.0100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 26.142857 $1411.7200 $54.0000
INTR -T1013 INTERPRETER 21 31 58.500000 $2925.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 22.000000 $264.0000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 40.571428 $3299.2700 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.133333 $30.6100 $229.5500
SENS -V5264 EARMOLD 1 1 0.400000 $7.2500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 27.857142 $2265.3500 $81.3200
TRAV -TRAVS Travel by mile 5 10 506.000000 $225.1700 $0.4500
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Subtotal (Total Children Is Unduplicated) 403 1245 3211.277951 $141974.4400 $44.2100
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Total 1303 3275.938552 $144213.6300 $44.0200
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Number of Children (Unduplicated) With at Least One Authorization 419