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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3705 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
TCM -T1017TL TARGETED CASE MANAGEMENT 39 43 26.033333 $968.4400 $37.2000
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Subtotal (Total Children Is Unduplicated) 39 43 26.033333 $968.4400 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.8400 $15.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 17 17 17.000000 $770.4400 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 35 40 16.638889 $855.4100 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.316667 $16.2800 $51.4200
OCTH -97167 OT EVAL HIGH COMPLEXITY 37 37 14.927778 $767.4400 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.438889 $22.5600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.161111 $59.6900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 17 23 7.655554 $393.5600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 14 4.488889 $230.7700 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 68 82 34.250002 $1760.8000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 1.905556 $97.9700 $51.4100
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Subtotal (Total Children Is Unduplicated) 128 225 101.783335 $5093.5900 $50.0400
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 673 808 804.292054 $40214.6300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 95 121 182.690475 $9134.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 755 907 750.814280 $37540.7500 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 2.571429 $64.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 83 109 875.571434 $21889.2600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 947 1181 10006.400011 $500319.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 78 101 536.857140 $38632.2400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 12.857143 $925.2000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 39 56 320.857142 $23088.8800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 96 125 671.928563 $48352.0000 $71.9600
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 4.000000 $230.4000 $57.6000
TRAV -TRAVS Travel by mile 20 25 175.053969 $77.9000 $0.4400
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Subtotal (Total Children Is Unduplicated) 1017 3437 14343.893640 $720469.7800 $50.2300
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Total 3705 14471.710308 $726531.8100 $50.2000
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Number of Children (Unduplicated) With at Least One Authorization 1037