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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 659 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 2 2 2.188889 $81.4300 $37.2000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 8 11.276190 $419.4700 $37.2000
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Subtotal (Total Children Is Unduplicated) 9 10 13.465079 $500.9000 $37.2000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 24 25 30.285714 $1759.9000 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 7 7 7.000000 $406.7700 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 13 13 39.142857 $2274.5900 $58.1100
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Subtotal (Total Children Is Unduplicated) 44 48 79.428571 $4615.5900 $58.1100
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 2.333333 $116.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 8.928571 $446.4300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.733333 $36.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 3 6.000000 $300.0000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 5.142857 $257.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 7.119047 $177.9800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 176 207 1674.776217 $90437.8000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 50.714286 $2738.5700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 86 108 782.166668 $63605.7900 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 9.000000 $731.8800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 10.571429 $859.6700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 13 18 175.142857 $11405.2900 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 2 12.857143 $837.2500 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.142857 $11.6200 $81.3400
PHY -97110 PT SESSION BY LICENSED PT 44 52 334.561905 $27206.5700 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 5.528571 $449.5900 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 153 188 1308.814295 $106432.7300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 28.571429 $2323.4300 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 2 12.857143 $1045.5500 $81.3200
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Subtotal (Total Children Is Unduplicated) 373 601 4436.961941 $309445.6200 $69.7400
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Total 659 4529.855591 $314562.1200 $69.4400
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Number of Children (Unduplicated) With at Least One Authorization 387