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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 448 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 1 2 4.571428 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.733333 $64.4800 $37.2000
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Subtotal (Total Children Is Unduplicated) 2 3 6.304761 $64.4800 $10.2300
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 19 19 20.142857 $1035.5500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 9.000000 $462.6900 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 11 11.000000 $565.5100 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 7.000000 $359.8700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $154.2300 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 51 54 55.142857 $2834.9000 $51.4100
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.866667 $43.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 1.666667 $83.3400 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 16.719047 $835.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 96 105 912.533328 $45626.7400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 8 90.142857 $4507.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 102 127 1265.019048 $91030.8500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 4 61.428572 $4420.3900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 11 11 124.714286 $8974.4500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 8.714286 $627.0800 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 26.285714 $1891.5200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 106 120 1239.928569 $89225.3600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 9 92.333332 $6644.3200 $71.9600
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Subtotal (Total Children Is Unduplicated) 273 391 3840.352373 $253910.4700 $66.1200
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Total 448 3901.799991 $256809.8500 $65.8200
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Number of Children (Unduplicated) With at Least One Authorization 293