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
Eligibility Filter: Program Patients
With the filters selected there were 5742 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 60 64 41.796822 $1554.8300 $37.2000
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Subtotal (Total Children Is Unduplicated) 60 64 41.796822 $1554.8300 $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 34 34 34.000000 $1540.8800 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 89 110 47.883334 $2461.6900 $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 77 77 58.378573 $3001.2400 $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 33 44 13.944444 $716.8800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 28 28 10.794445 $554.9500 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 0.888889 $45.7000 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 196 264 138.416669 $7116.0100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 17 8.894446 $457.2700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 2.216667 $99.4400 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 5.571429 $294.8900 $52.9300
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Subtotal (Total Children Is Unduplicated) 342 587 325.905563 $16506.1500 $50.6500
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 4 1.000000 $50.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 917 1113 1089.512688 $54475.6800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 122 155 227.293650 $11364.7000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1023 1235 1040.389674 $52019.5200 $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 116 153 1225.428577 $30635.6800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 52.428571 $2621.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1380 1773 14636.369863 $731818.0200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 155 203 1179.888091 $84904.7300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 12.857143 $925.2000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.900000 $51.8400 $57.6000
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 9.428571 $543.0900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 65 93 530.714283 $38190.2100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 232 306 1955.138089 $140691.7200 $71.9600
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 4.000000 $230.4000 $57.6000
TRAV -TRAVS Travel by mile 34 43 323.792064 $144.0900 $0.4400
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Subtotal (Total Children Is Unduplicated) 1497 5091 22292.712693 $1148780.5700 $51.5300
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Total 5742 22660.415078 $1166841.5500 $51.4900
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Number of Children (Unduplicated) With at Least One Authorization 1531