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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5466 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 53 57 49.731744 $1850.0100 $37.2000
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Subtotal (Total Children Is Unduplicated) 53 57 49.731744 $1850.0100 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 19 19 19.000000 $861.0800 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 35 43 16.477777 $957.5200 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.022222 $59.4000 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 48 49 36.355556 $2112.6200 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 21 30 9.772219 $567.8500 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 22 22 28.642858 $1664.4400 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 57 61 33.594445 $1952.1800 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $29.7000 $58.1100
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Subtotal (Total Children Is Unduplicated) 140 229 148.376188 $8379.1200 $56.4700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 16 5.983334 $299.1700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 710 900 1007.189658 $50359.2700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 77 93 163.818255 $8190.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1101 1396 1047.097548 $52354.5100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.022222 $51.1100 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 155 210 1687.571415 $45564.4900 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1518 1996 18223.474484 $984068.6100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 158 209 1023.712715 $83248.2700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 4 27.857143 $1814.0500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 81 112 538.000013 $43750.1300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 2 3 36.857143 $2400.1300 $65.1200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 151 200 903.701608 $73488.9500 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 19.285714 $1255.8900 $65.1200
TRAV -TRAVS Travel by mile 29 36 279.104762 $124.2000 $0.4500
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Subtotal (Total Children Is Unduplicated) 1652 5180 24965.676014 $1346987.8100 $53.9500
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Total 5466 25163.783946 $1357216.9400 $53.9400
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Number of Children (Unduplicated) With at Least One Authorization 1683