Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 1573 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 70 81 88.396821 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 70 81 88.396821 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EXIT -EXIT COS Exit 121 122 122.000000 $6100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 122 123 123.000000 $6215.8100 $50.5400
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 3 4.088889 $283.5700 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 90 94 76.335038 $3816.7500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 63 64 66.065253 $3303.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 8 4.511111 $112.7800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 12 15 28.750002 $1437.5100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 5.516667 $275.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 7 11.216667 $560.8400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 8.333334 $416.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 5 9.200001 $460.0100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 1.450000 $72.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 37 44 385.914282 $20839.4000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 7 44.371428 $2396.0600 $54.0000
INTR -T1013 INTERPRETER 74 123 818.830952 $40941.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 713 983 7642.636436 $91711.7400 $12.0000
SENS -V5060 BEHIND EAR HEARING AID 1 2 2.000000 $459.2200 $229.6100
SENS -V5264 EARMOLD 2 2 1.355555 $24.5800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 38.857143 $3159.8600 $81.3200
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Subtotal (Total Children Is Unduplicated) 748 1369 9152.499425 $170425.4300 $18.6200
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Total 1573 9363.896246 $176641.2400 $18.8600
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Number of Children (Unduplicated) With at Least One Authorization 812