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
Eligibility Filter: Program Patients
With the filters selected there were 3490 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 4 4 3.144445 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 34 36 27.766664 $1032.9100 $37.2000
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Subtotal (Total Children Is Unduplicated) 38 40 30.911109 $1032.9100 $33.4200
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 5.000000 $226.6000 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 20 26 11.755556 $604.3600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.511111 $77.6900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 18 11.427778 $587.5000 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 13 7.100000 $365.0100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 7 15.898412 $817.3400 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 64 78 62.410317 $3208.5200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 8 3.827778 $196.7900 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 3.272222 $146.7900 $44.8600
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Subtotal (Total Children Is Unduplicated) 101 163 123.714285 $6308.2800 $50.9900
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.428571 $99.2700 $231.6400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 3 1.016667 $50.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 2 1.022222 $51.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 867 1095 1061.350755 $53067.2700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 120 159 221.914283 $11095.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 983 1226 1049.718995 $52485.6400 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 14.000000 $350.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 66.571428 $3328.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 486 656 5304.215870 $265210.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4 4 41.142857 $411.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 25 148.257145 $10668.5700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 11.000000 $633.6000 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 9 12 83.857141 $6034.3700 $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 41 50 382.703966 $27539.4100 $71.9600
TRAV -TRAVS Travel by mile 36 45 332.334919 $147.8900 $0.4500
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Subtotal (Total Children Is Unduplicated) 1327 3287 8722.963390 $431371.9000 $49.4500
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Total 3490 8877.588784 $438713.0900 $49.4200
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Number of Children (Unduplicated) With at Least One Authorization 1374