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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4648 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 47 50 41.104764 $1529.1000 $37.2000
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Subtotal (Total Children Is Unduplicated) 47 50 41.104764 $1529.1000 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 18 18 18.000000 $815.7600 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 30 33 14.866666 $863.9000 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.322222 $18.7200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 45 45 34.650000 $2013.5100 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 15 17 7.116666 $413.5500 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 19 23.196032 $1347.9200 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 52 53 32.833332 $1907.9400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 0.500000 $29.0600 $58.1100
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Subtotal (Total Children Is Unduplicated) 124 194 137.484918 $7759.0100 $56.4400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 9 2.061113 $103.0700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 664 759 877.823805 $43891.2500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 58 137.603168 $6880.1600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1048 1197 983.292067 $49164.6300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 2 1.000000 $50.0000 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 141 173 1403.142872 $37884.8200 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1478 1743 16889.669946 $912041.3400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 146 174 889.463481 $72331.1200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 4 29.142857 $1897.7800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 81 91 491.928564 $40003.6100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 25.714286 $1674.5200 $65.1200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 129 155 709.928555 $57731.4100 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 7.071429 $460.4900 $65.1200
TRAV -TRAVS Travel by mile 32 35 306.219050 $136.2700 $0.4400
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Subtotal (Total Children Is Unduplicated) 1603 4404 22755.061193 $1224268.5700 $53.8000
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Total 4648 22933.650875 $1233556.6900 $53.7900
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Number of Children (Unduplicated) With at Least One Authorization 1638