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: 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 1776 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 1 1 1.022222 $38.0300 $37.2000
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Subtotal (Total Children Is Unduplicated) 1 1 1.022222 $38.0300 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.966667 $89.1300 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 3 0.827778 $42.5600 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 13 13 4.694445 $241.3400 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 5 1.850000 $95.1100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 7 4.038889 $207.6400 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 19 22 9.888888 $508.3800 $51.4100
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Subtotal (Total Children Is Unduplicated) 30 52 23.266667 $1184.1600 $50.9000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 5 2.555555 $127.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 605 710 647.888852 $32394.2500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 70 86 132.207931 $6610.3600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 726 844 661.347567 $33067.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 38 50 352.428571 $17621.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 10.285715 $740.1600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 4 62.714285 $4512.9200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 10.857143 $781.2800 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 3 13.142858 $757.0300 $57.6000
TRAV -TRAVS Travel by mile 15 18 129.071427 $57.4400 $0.4500
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Subtotal (Total Children Is Unduplicated) 883 1723 2022.499904 $96669.7600 $47.8000
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Total 1776 2046.788793 $97891.9500 $47.8300
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Number of Children (Unduplicated) With at Least One Authorization 897