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 1943 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 8 10 6.466666 $240.5600 $37.2000
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Subtotal (Total Children Is Unduplicated) 8 10 6.466666 $240.5600 $37.2000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 2.411111 $123.9500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.266667 $13.7100 $51.4200
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 2 0.388889 $19.9900 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 7 3.911111 $201.0700 $51.4100
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Subtotal (Total Children Is Unduplicated) 7 14 6.977778 $358.7300 $51.4100
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 -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 11.142857 $278.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 35 48 392.920634 $19646.0300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 18.428572 $1326.1100 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 2 3 21.142857 $1521.4400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 39.142857 $2816.7200 $71.9600
TRAV -TRAVS Travel by mile 20 25 175.053969 $77.9000 $0.4400
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Subtotal (Total Children Is Unduplicated) 904 1919 2395.628555 $112556.6900 $46.9800
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Total 1943 2409.072999 $113155.9800 $46.9700
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Number of Children (Unduplicated) With at Least One Authorization 913