Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3610 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
TCM -T1017TL TARGETED CASE MANAGEMENT 47 56 29.496829 $1091.4000 $37.0000
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Subtotal (Total Children Is Unduplicated) 47 56 29.496829 $1091.4000 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 1.338889 $68.3500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 53 58 29.842854 $1523.4700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.338889 $17.3000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 20 10.455555 $533.7500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 47 53 26.781743 $1367.2000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 1.188889 $52.9700 $44.5500
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Subtotal (Total Children Is Unduplicated) 71 138 69.946819 $3563.0300 $50.9400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 8 0.966668 $48.3400 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 365 444 459.072210 $22953.5300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 70 87 181.292063 $9064.5900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 516 619 501.477745 $25073.7200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 71 75 690.714281 $17267.9000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 807 995 8203.665033 $410183.8500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 806 996 8184.139638 $81841.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 75 81 456.785730 $32632.7200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 3 18.428572 $1054.1200 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 8.571429 $612.3400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 24 26 162.857145 $11634.5200 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 1 1 8.714286 $622.5500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 73 79 404.785729 $28917.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 8.714286 $120.9500 $13.8800
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Subtotal (Total Children Is Unduplicated) 869 3416 19290.184815 $642028.4600 $33.2800
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Total 3610 19389.628463 $646682.9000 $33.3500
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Number of Children (Unduplicated) With at Least One Authorization 903