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
Eligibility Filter: Program Patients
With the filters selected there were 220 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 5 6 10.076191 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.466667 $54.5600 $37.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6 7 11.542858 $54.5600 $4.7300
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 0.750000 $37.5000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 15 15 26.571429 $1366.0400 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 5.000000 $257.0500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 6 6.000000 $308.4600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97162TLGT PT EVAL MODERATE 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 1 1 1.000000 $51.4100 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 32 34 45.321429 $2328.9200 $51.3900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.250000 $6.2500 $25.0000
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 8 10 85.719048 $4285.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 22 26 218.352381 $10917.6400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 10.966667 $548.3400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 43 427.352379 $30752.3200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.571429 $41.1200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 15 19 160.857143 $11575.2800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 13.142857 $945.7600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 63 69 688.428577 $49539.3300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 13.876190 $998.5300 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 12.285714 $884.0800 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 11.428571 $159.5400 $13.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 121 179 1646.764290 $115780.8100 $70.3100
-------------------------------------------------------------------------------------------------------------------------------------
Total 220 1703.628577 $118164.2900 $69.3600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 136