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: 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 2042 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 13 13 11.766667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 11.766667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 7 8 7.544444 $881.4100 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 2.000000 $233.6600 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 51 61 43.149999 $2092.7700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 14 16 9.588888 $591.7200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 4 2.661111 $40.4200 $15.1900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 3 1.022222 $16.5100 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 31 33 27.222220 $660.9500 $24.2800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $49.5900 $49.5900
AUDE -V5010 ASSESSMENT FOR HEARING AID 33 36 22.908730 $1038.2300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.266667 $146.7000 $115.8100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 5.973015 $347.0900 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 13.142857 $763.7300 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.944444 $54.8800 $58.1100
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Subtotal (Total Children Is Unduplicated) 134 173 138.424597 $6917.6700 $49.9700
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 9 10 11.711111 $561.4300 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.333333 $15.9800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 29 35 51.033332 $255166.0000 $4999.9900
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.133333 $9.2400 $69.3300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 153 173 150.758734 $7537.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 6 6 7.111111 $355.5600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.238889 $11.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 -1.450000 $-72.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 6 -3.055556 $-152.7800 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 14.587301 $393.8600 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 552 751 4329.339686 $233784.6000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 78 95 566.196029 $30574.6500 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 81 92 159.901585 $13003.1900 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 7 8 29.849207 $2427.3400 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 10 11 18.839684 $1532.0400 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 6.571429 $534.3900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 11 16 59.614285 $3882.0900 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 2 13.142857 $855.8600 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 83 102 349.443647 $28416.7700 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 25 29 102.657938 $8348.1300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 5.000000 $325.6000 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 14 21 48.072221 $3130.4800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 77 81 297.397618 $24184.3800 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 6 7 30.960317 $2517.7000 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 4 5 52.038096 $4231.7400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 6 6 27.088889 $2202.8800 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 73 86 249.280953 $20271.5300 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 2 3 13.428572 $1092.0100 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 7.285714 $592.4700 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.755556 $346.9900 $459.2500
SENS -V5264 EARMOLD 4 6 14.326985 $259.7500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 132 156 327.061107 $26596.6000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 12 38.294445 $3114.0900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 101 117 144.102376 $11718.3500 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 13.157143 $1069.9400 $81.3200
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Subtotal (Total Children Is Unduplicated) 812 1856 7135.279356 $688846.0400 $96.5400
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Total 2042 7285.470620 $695763.7100 $95.5000
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Number of Children (Unduplicated) With at Least One Authorization 823