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 149 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 20 21 28.633333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
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 1 1 0.511111 $7.7600 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 5 2.683333 $65.1500 $24.2800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 16 19 12.972222 $560.3500 $43.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 5.044444 $25222.0000 $4999.9600
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 45 47 327.325391 $17675.5700 $54.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 1.044445 $84.9400 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 2 3.423810 $278.4200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 6.333333 $515.0200 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 13.142857 $1068.7800 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 2 2 1.666666 $30.2200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 36.285715 $2950.7700 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 6.133333 $498.7600 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 94 109 477.065867 $52336.8200 $109.7100
-------------------------------------------------------------------------------------------------------------------------------------
Total 149 518.671422 $52897.1700 $101.9900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 115