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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 9351 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 27 29 47.573015 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 29 47.573015 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 3 7.000000 $723.5200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 233 379 417.419048 $20244.8300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 42 49 52.004262 $2917.4400 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 4 2.061110 $32.6500 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 6 6 5.561112 $108.5000 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 3 2.061111 $48.7900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 8 6.294445 $92.4000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 83 100 115.840477 $2556.6000 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 6 6.266666 $55.2100 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 3 3.027778 $87.5600 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 1.061111 $47.8300 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 7 8.127777 $112.2400 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 11 7.333333 $154.2900 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.872222 $53.2000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 4 4 3.194444 $277.7200 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 2 1.772222 $133.1500 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 36 43 40.649999 $1842.2500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 4 1.988889 $230.3300 $115.8100
EXIT -EXIT EXIT ASSESSMENT 4 4 6.000000 $300.0000 $50.0000
SCREEN-T1023 SCREENING 2 2 1.844445 $92.2300 $50.0000
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Subtotal (Total Children Is Unduplicated) 369 641 690.380451 $30110.7500 $43.6100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 83 102 163.807935 $819039.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 8 8 32.957936 $1647.9000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.197260 $83.0300 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 14 17 17.705554 $4100.9200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 511 828 746.076596 $37303.8700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 58 80 56.172225 $2808.6300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 140 194 425.584916 $21279.2200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 20 21 35.177777 $1758.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 2 3.311111 $82.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 322 417 767.425398 $38371.2700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 32 35 51.338889 $2566.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 9 10 35.332538 $883.3100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 180 256 450.216665 $22510.8300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 15 16 14.951588 $747.5800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 465 668 1168.054761 $58402.7300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 34 37 29.289684 $1464.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 11 9.044445 $226.1100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.077778 $1.9500 $25.0100
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 6 45.073016 $2253.6500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 853 1444 15417.763482 $770888.1200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 173 221 1759.118255 $87955.9000 $50.0000
INTR -T1013 INTERPRETER 1 2 25.571429 $1278.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1222 3604 26294.663461 $315535.9200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 64 90 1141.868256 $82168.8700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 14 21 263.706349 $18976.3000 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 79 111 1192.810316 $85834.6200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 9 10 43.253174 $3112.4900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 62 86 1012.563491 $72864.0700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 6 41.604763 $2993.8800 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 91 139 1285.850002 $92529.7500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 12 14 79.936509 $5752.2400 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.944444 $223.2400 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 10 14.744444 $6770.9200 $459.2200
SENS -V5264 EARMOLD 8 11 25.766667 $467.1500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 48 61 653.739682 $47043.1200 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 11.571429 $832.6800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 88 129 1510.177776 $108672.3900 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 8 67.647619 $4867.9200 $71.9600
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Subtotal (Total Children Is Unduplicated) 1276 8681 54898.097620 $2724370.5700 $49.6300
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Total 9351 55636.051086 $2754481.3200 $49.5100
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Number of Children (Unduplicated) With at Least One Authorization 1289