Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 51
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 485 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.677778 $25.2100 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 4 4 14.195238 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 14.873016 $25.2100 $1.7000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 26 26 30.000000 $1542.3000 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 7.066667 $363.3000 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.000000 $205.6400 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 6.000000 $308.4600 $51.4100
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Subtotal (Total Children Is Unduplicated) 47 51 57.066667 $2933.8000 $51.4100
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 1.022222 $51.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.233333 $5.8300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 8.285714 $414.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 124 141 1213.057147 $60652.9200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 13 141.142856 $7057.1600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 77 93 842.142852 $60600.6500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 20.233333 $1455.9900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 10 12 148.571429 $8557.7200 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 21 25 205.428574 $14782.6600 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 3 15.428572 $1110.2300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 9.142857 $657.9200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 91 116 1001.142857 $72042.3100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 12 15 136.285714 $9807.1400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 8.780953 $631.8800 $71.9600
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Subtotal (Total Children Is Unduplicated) 284 429 3767.107937 $238926.8900 $63.4200
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Total 485 3839.047620 $241885.9100 $63.0100
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Number of Children (Unduplicated) With at Least One Authorization 298