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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1804 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 29 30 22.158726 $1012.1900 $45.6800
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Subtotal (Total Children Is Unduplicated) 29 30 22.158726 $1012.1900 $45.6800
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 6 2.333334 $135.5900 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 18 17.511111 $1017.5700 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 9 2.900000 $168.5200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 8.511111 $494.5800 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 21 21 17.977779 $1044.7000 $58.1100
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Subtotal (Total Children Is Unduplicated) 33 63 49.233335 $2860.9600 $58.1100
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 87 98 97.689680 $4884.4700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 15 28.328572 $1416.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 141 160 134.105549 $6705.2300 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 95 105 995.714275 $26884.3500 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 942 1071 11009.517362 $594514.6500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 5.285714 $285.4300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 77 86 460.646045 $37459.7000 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 5 6 38.071430 $2479.2100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 41 48 236.857151 $19261.1900 $81.3200
PHY -97110HM PT SESSION BY PT ASST 9 10 63.857145 $4158.3700 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 87 402.111126 $32699.6200 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 8 53.142860 $3460.6500 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 16.785715 $1093.0800 $65.1200
TRAV -TRAVS Travel by mile 10 13 89.214286 $39.7000 $0.4500
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Subtotal (Total Children Is Unduplicated) 1037 1711 13631.326910 $735342.0700 $53.9500
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Total 1804 13702.718971 $739215.2200 $53.9500
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Number of Children (Unduplicated) With at Least One Authorization 1062