Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 51
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 573 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 10 11 21.492064 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 2.366666 $87.5600 $37.0000
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Subtotal (Total Children Is Unduplicated) 13 14 23.858730 $87.5600 $3.6700
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 2 3 3.000000 $150.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 20 21 21.000000 $1072.0500 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 8.285714 $422.9900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 5.000000 $255.2500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $133.6500 $44.5500
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Subtotal (Total Children Is Unduplicated) 47 53 52.285714 $2646.5400 $50.6200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.750000 $37.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.066667 $1.6700 $25.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 3.700000 $185.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 5.857143 $146.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 166 191 2077.580947 $103879.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 94 113 1246.428571 $89044.9300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 38 42 451.026189 $32221.3300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 7.142857 $510.2900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 128 147 1705.188090 $121818.7500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.857143 $61.2300 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 3 3 19.142857 $265.7000 $13.8800
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Subtotal (Total Children Is Unduplicated) 329 506 5537.016655 $349417.5800 $63.1100
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Total 573 5613.161099 $352151.6800 $62.7400
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Number of Children (Unduplicated) With at Least One Authorization 352