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: 10-01-22 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 1941 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 3 3 2.400001 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 12 14 11.433332 $425.3100 $37.2000
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Subtotal (Total Children Is Unduplicated) 15 17 13.833333 $425.3100 $30.7500
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 5 1.533334 $78.8300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 1.538889 $79.1100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 1.511111 $77.6900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 2.994445 $153.9500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.000000 $89.7200 $44.8600
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Subtotal (Total Children Is Unduplicated) 13 24 10.600001 $531.8500 $50.1700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 3 1.016667 $50.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 635 787 785.495204 $39274.5400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 93 120 176.126984 $8806.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 717 886 755.276145 $37763.5500 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 13.142857 $328.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 45 57 497.341271 $24867.0800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 36.142857 $361.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 4 20.114287 $1447.4200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 2 2 26.285714 $1891.5300 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 3.428571 $197.3500 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 8 68.214285 $4908.7200 $71.9600
TRAV -TRAVS Travel by mile 23 29 191.268253 $85.1100 $0.4500
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Subtotal (Total Children Is Unduplicated) 872 1900 2573.853095 $119982.4500 $46.6200
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Total 1941 2598.286429 $120939.6200 $46.5500
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Number of Children (Unduplicated) With at Least One Authorization 890