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 2838 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 19 20 19.282540 $717.3100 $37.2000
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Subtotal (Total Children Is Unduplicated) 19 20 19.282540 $717.3100 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 6 7 4.044444 $235.0200 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.322222 $18.7200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 9.150000 $531.7100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 13 4.900000 $284.7400 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 4.166667 $242.1300 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 16 16 10.494444 $609.8300 $58.1100
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Subtotal (Total Children Is Unduplicated) 38 57 36.077777 $2083.6900 $57.7600
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 575 683 6687.573058 $361128.6000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 56.114286 $4563.2100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 9 10 109.142859 $8875.4800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 6.714286 $546.0100 $81.3200
TRAV -TRAVS Travel by mile 32 35 306.219050 $136.2700 $0.4400
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Subtotal (Total Children Is Unduplicated) 1390 2761 9167.543692 $475338.6600 $51.8500
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Total 2838 9222.904009 $478139.6500 $51.8400
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Number of Children (Unduplicated) With at Least One Authorization 1423