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 3466 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 29 31 22.230155 $826.9500 $37.2000
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Subtotal (Total Children Is Unduplicated) 29 31 22.230155 $826.9500 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 6.000000 $271.9200 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 26 30 12.483334 $641.7700 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 14 14 10.455556 $537.5200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 11 2.388890 $122.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 6 1.777777 $91.3900 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 52 71 42.899998 $2205.4800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 6 4.472223 $229.9200 $51.4100
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Subtotal (Total Children Is Unduplicated) 88 144 80.477778 $4100.8200 $50.9600
EI Services, Class # 03
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 -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 11.142857 $278.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 52.428571 $2621.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 467 639 5015.604772 $250780.0600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 25 30 210.142857 $15121.8600 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 9.428571 $543.0900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 7 11 63.999999 $4605.4400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 39 53 452.785716 $32582.4700 $71.9600
TRAV -TRAVS Travel by mile 34 43 323.792064 $144.0900 $0.4400
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Subtotal (Total Children Is Unduplicated) 1350 3291 8497.521419 $424586.8800 $49.9700
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Total 3466 8600.229352 $429514.6500 $49.9400
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Number of Children (Unduplicated) With at Least One Authorization 1385