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
Eligibility Filter: Program Patients
With the filters selected there were 2711 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 39 41 39.434916 $1801.3700 $45.6800
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Subtotal (Total Children Is Unduplicated) 39 41 39.434916 $1801.3700 $45.6800
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 14 14.000000 $634.4800 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 18 21 9.200000 $534.6100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 32 32 30.633333 $1780.1000 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 16 18 5.038888 $292.8000 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 14 12.633333 $734.1200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 35 36 30.083334 $1748.1500 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.644444 $95.5600 $58.1100
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Subtotal (Total Children Is Unduplicated) 76 138 103.233332 $5819.8200 $56.3800
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 144 167 180.781745 $9039.0800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 17 32.300001 $1615.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 224 254 204.465862 $10223.2200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 123 137 1258.142842 $33969.9400 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1399 1593 16435.417320 $887513.5800 $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 105 118 686.931763 $55861.2500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 12 13 79.142861 $5153.7800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 55 64 345.582548 $28102.7500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 12 13 88.785717 $5781.7200 $65.1200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 103 114 549.182560 $44659.4600 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 12 72.857147 $4744.4400 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 16.785715 $1093.0800 $65.1200
TRAV -TRAVS Travel by mile 20 25 170.728573 $75.9700 $0.4500
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Subtotal (Total Children Is Unduplicated) 1517 2532 20127.390368 $1088136.8300 $54.0600
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Total 2711 20270.058616 $1095758.0200 $54.0600
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Number of Children (Unduplicated) With at Least One Authorization 1550