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: 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 4564 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 9 9 22.468255 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 14 18 24.488888 $910.9800 $37.2000
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Subtotal (Total Children Is Unduplicated) 23 27 46.957143 $910.9800 $19.4000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 9 13 8.416667 $432.7000 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.266667 $13.7100 $51.4200
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 4.972223 $255.6300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.222222 $11.4200 $51.4000
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 7 4.261111 $219.0600 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 4.402381 $226.3300 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.222222 $11.4200 $51.4000
SPCH -92521 EVAL OF SPEECH FLUENCY 19 27 11.772223 $605.2100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 3.311111 $170.2200 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.000000 $102.8200 $51.4100
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Subtotal (Total Children Is Unduplicated) 34 72 39.846827 $2048.5300 $51.4100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 4 2.050000 $102.5000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1187 1850 3368.339662 $168416.9400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 149 260 711.619048 $35580.9500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1348 2054 3242.417439 $162120.7700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 20 103.142856 $2578.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 2 14.000000 $700.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 83 144 2110.139686 $105506.9700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 12 12 132.714286 $1592.5700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 17 81.500001 $5864.7300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 2 2 5.571429 $320.9100 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 6 7 84.071427 $6049.7900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 3 3 23.285715 $1340.3200 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 24 33 205.500001 $14787.7900 $71.9600
TRAV -TRAVS Travel by mile 35 56 701.096826 $311.9900 $0.4400
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Subtotal (Total Children Is Unduplicated) 1601 4465 10786.448376 $505324.7900 $46.8500
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Total 4564 10873.252346 $508284.3100 $46.7500
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Number of Children (Unduplicated) With at Least One Authorization 1616