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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 4053 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 32 33 17.200000 $639.8400 $37.2000
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Subtotal (Total Children Is Unduplicated) 32 33 17.200000 $639.8400 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 6.000000 $271.9200 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 17 13.685714 $795.2800 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.466667 $27.1200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 16 6.861113 $398.7100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 15 16 8.305555 $482.6300 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 14 9.911113 $575.9500 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 30 36 19.274606 $1120.0600 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.022222 $1.2900 $58.0500
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Subtotal (Total Children Is Unduplicated) 64 107 64.526990 $3672.9600 $56.9200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 15 3.733336 $186.6800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 547 702 656.103141 $32804.9300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 72 96 170.106354 $8505.3100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 798 996 742.769776 $37138.1600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 120 212 1025.071433 $27676.9900 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1084 1407 12319.701548 $665264.5400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 105 170 509.261124 $41412.9700 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 66 103 356.714299 $29007.9400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 26.285714 $1711.7200 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 118 196 520.093669 $42293.8600 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.142857 $855.8700 $65.1200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 1.500000 $97.6800 $65.1200
TRAV -TRAVS Travel by mile 11 13 104.571430 $46.5300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1144 3913 16449.054681 $887003.1700 $53.9200
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Total 4053 16530.781671 $891315.9700 $53.9200
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Number of Children (Unduplicated) With at Least One Authorization 1160