Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 1090 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 20 21 28.633333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.022222 $46.6900 $45.6800
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Subtotal (Total Children Is Unduplicated) 20 22 29.655555 $46.6900 $1.5700
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 12 8.777778 $425.7200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $61.7100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 1.511111 $22.9500 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 51 52 42.277777 $1026.5000 $24.2800
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 2.133333 $123.9700 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 3 36.571429 $2125.1600 $58.1100
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Subtotal (Total Children Is Unduplicated) 66 72 93.271428 $3902.8500 $41.8400
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.511111 $24.5000 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 10 13 15.311111 $76555.5000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 10 11 11.000000 $2547.8200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 14 16 11.925397 $596.2700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 3 3 1.750000 $87.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 6.503175 $325.1600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 10 31.153969 $1557.7000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 1.022222 $51.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 8 8 21.288888 $1064.4400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.022222 $0.5600 $24.9800
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 481 565 3526.701556 $190442.0500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 18 113.399999 $6123.6000 $54.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 24 26 102.588093 $8342.4700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 13 13 42.930953 $3491.1500 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 2 2 6.419047 $521.9900 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 23.571428 $1916.8300 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 16 17 94.303969 $7668.8200 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 60 69 319.037298 $25944.1400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 16 16 44.955555 $3655.7800 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 8 9 45.225397 $3677.7400 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 17.009524 $1383.2200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 9.142857 $743.5000 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 42 51 256.711905 $20875.8000 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 3 3 2.688888 $48.7500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 44 48 244.995240 $19923.0300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 8 44.066667 $3583.5000 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 65 75 338.140476 $27497.5900 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 4.900000 $398.4700 $81.3200
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Subtotal (Total Children Is Unduplicated) 673 996 5340.276947 $409378.5900 $76.6600
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Total 1090 5463.203930 $413328.1400 $75.6600
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Number of Children (Unduplicated) With at Least One Authorization 686