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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1129 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 1 1 0.166667 $6.2000 $37.2100
SCONLY-SCONLY *SERVICE COORDINATION ONLY 7 9 37.995237 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.733333 $64.4800 $37.2000
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Subtotal (Total Children Is Unduplicated) 9 11 39.895237 $70.6800 $1.7700
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 2 2 1.500000 $75.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 2.000000 $102.8200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 75 78 127.714285 $6565.7900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 22 22 42.142857 $2166.5700 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 19 19.000000 $976.7900 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 12 12 12.000000 $616.9200 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 6.000000 $308.4600 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 146 159 228.357142 $11737.7300 $51.4000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.750000 $37.5000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 7.966666 $398.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.433333 $21.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.066667 $76.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 6 101.023808 $5051.2000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 201 277 4701.147611 $235057.4900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 20 374.142856 $18707.1600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 190 282 5086.695236 $366038.6400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 9 14 334.833332 $24094.6000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 10 11 82.142857 $4731.4300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 32 54 836.547619 $60197.9500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 29.571429 $2127.9600 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 52.000000 $3741.9200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 184 261 5067.157139 $364632.6700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 18 23 333.352379 $23988.0500 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 2 10.285715 $740.1600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 23.142857 $323.0700 $13.9600
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Subtotal (Total Children Is Unduplicated) 497 959 17044.259504 $1109966.4600 $65.1200
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Total 1129 17312.511883 $1121774.8700 $64.8000
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Number of Children (Unduplicated) With at Least One Authorization 543