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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 723 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 4.766667 $177.3200 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 1 1 1.100000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 6 8.955554 $333.1400 $37.2000
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Subtotal (Total Children Is Unduplicated) 10 10 14.822221 $510.4600 $34.4400
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 34 34 40.000000 $2324.4000 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 2 2.000000 $116.2200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 6.000000 $348.6600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 10 10 48.285714 $2805.8900 $58.1100
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Subtotal (Total Children Is Unduplicated) 47 53 97.285714 $5653.2800 $58.1100
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 15.404761 $770.2400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.711111 $67.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.833333 $91.6700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 3 5.900000 $295.0000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 6.571429 $328.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.777778 $144.4500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 174 213 1702.280953 $91923.2700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 6 40.352381 $2179.0300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 107 132 1030.252375 $83780.2400 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 2 13.142858 $1068.7700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 -77.428571 $-6296.4900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 19 25 260.714285 $16977.7200 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 9.857143 $641.8900 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 12.142857 $790.7500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 43 51 370.745238 $30149.0600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 3.428571 $278.8100 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 168 207 1757.528561 $142922.4200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 19.000000 $1545.0800 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 10.857143 $882.9000 $81.3200
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Subtotal (Total Children Is Unduplicated) 404 660 5197.205540 $368847.8000 $70.9700
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Total 723 5309.313475 $375011.5400 $70.6300
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Number of Children (Unduplicated) With at Least One Authorization 418