Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2371 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 122 131 111.567453 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 122 131 111.567453 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 6.244444 $350.3100 $56.1000
OCTH -97165TL OT EVAL LOW COMPLEXITY 3 3 1.516668 $77.9800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.505556 $25.9900 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 18 18 6.638890 $341.3100 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.372222 $19.1300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 0.744445 $38.2700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 20 23 8.383336 $431.0000 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 1.011111 $51.9800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 24 27 8.794447 $452.1400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 0.516666 $26.5600 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.133333 $6.8500 $51.4000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.8200 $51.4100
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Subtotal (Total Children Is Unduplicated) 57 92 37.061118 $1934.6300 $52.2000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 152 53.524998 $2676.2400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 12 12 23.907938 $1195.4000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 3.111110 $77.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 24 38.900793 $1945.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 2.366666 $59.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.355556 $17.7800 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.744444 $18.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 9 9 4.640476 $232.0200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 14 78.285713 $1957.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 21.714286 $1085.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 31 33 251.714284 $12585.7300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 252 290 2765.630155 $138281.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1256 1541 13949.584115 $167395.0500 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 13 13 103.714284 $7463.2900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 2 2 6.142858 $442.0400 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 21 22 159.285716 $11462.2100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 10.857143 $781.2800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 22 25 180.071429 $12957.9600 $71.9600
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Subtotal (Total Children Is Unduplicated) 1341 2148 17654.551964 $360633.9800 $20.4300
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Total 2371 17803.180535 $362568.6200 $20.3700
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Number of Children (Unduplicated) With at Least One Authorization 1442