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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1253 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 3 3 2.244444 $83.4900 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 8 9 22.342859 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 7 4.344444 $161.6100 $37.2000
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Subtotal (Total Children Is Unduplicated) 17 19 28.931747 $245.1000 $8.4700
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 72 72 75.285714 $4374.8500 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 17 17 17.000000 $987.8700 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 32 32 66.285715 $3851.8600 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 116 125 162.571429 $9447.0200 $58.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.000000 $25000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 2 3.066666 $153.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 16.209525 $810.4800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 6.888890 $344.4500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 2.366667 $118.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 7.600001 $380.0100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.285714 $64.2900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 10.933333 $273.3300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 21.285714 $1064.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 238 285 2199.700003 $118783.9800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 12 76.985714 $4157.2300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 193 231 2087.509525 $169756.4200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 8 9 50.157142 $4078.7900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 30 37 476.142851 $31006.4600 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 2 2 26.285714 $1711.7300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 80 108 677.654764 $55106.9400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 13.809524 $1123.0000 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 0.714286 $58.0900 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 308 380 3380.630156 $274913.1700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 13 64.352381 $5233.1500 $81.3200
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Subtotal (Total Children Is Unduplicated) 654 1109 9157.645237 $696328.4400 $76.0400
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Total 1253 9349.148413 $706020.5700 $75.5200
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Number of Children (Unduplicated) With at Least One Authorization 680