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
Eligibility Filter: Program Patients
With the filters selected there were 819 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 5 5 14.706349 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6 6 15.384127 $25.2100 $1.6400
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 48 48 3.428571 $176.2600 $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 -97166 OT EVAL MODERATE COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 7 7 9.066667 $466.1200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 3.000000 $154.2300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 10 11 12.447619 $639.9300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 7.000000 $359.8700 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 79 89 48.942857 $2514.7400 $51.3800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 9.200000 $460.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 3.455555 $172.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.233333 $5.8300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 8 61.142857 $3057.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 152 172 1446.690481 $72334.5900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 20 22 211.000000 $10550.0100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 132 164 1375.923806 $99011.5700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 64.090475 $4611.9500 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 14 16 191.857143 $11050.9800 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.142857 $238.6300 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 4.142857 $238.6300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 45 56 342.390480 $24638.4300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 5 31.571429 $2271.8800 $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 193 241 1838.190480 $132276.2700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 17 20 172.285714 $12397.7100 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 8.780953 $631.8800 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 463 724 5790.384134 $375676.9600 $64.8800
-------------------------------------------------------------------------------------------------------------------------------------
Total 819 5854.711118 $378216.9200 $64.6000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 483