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
Eligibility Filter: Program Patients
With the filters selected there were 8101 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 17 17 37.466668 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 64 71 81.574603 $3034.5800 $37.2000
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Subtotal (Total Children Is Unduplicated) 81 88 119.041271 $3034.5800 $25.4900
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 11 11.000000 $498.5200 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 39 59 38.922221 $2000.9900 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.266667 $65.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 43 43 51.688892 $2657.3400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.394444 $20.2800 $51.4000
PSTF -97164 PT RE-EVAL EST PLAN CARE 17 26 15.250000 $784.0000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 17 17 14.735714 $757.5600 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.016667 $52.2700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.222222 $11.4200 $51.4000
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 93 153 127.788098 $6569.6000 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.571429 $29.3800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 19 12.466666 $640.9100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 4.083334 $209.9300 $51.4100
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Subtotal (Total Children Is Unduplicated) 163 342 280.406354 $14348.7200 $51.1700
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 13.571429 $3143.4100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 4 2.050000 $102.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 6 3.311112 $165.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1611 2545 4531.473779 $226573.5600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 193 335 903.866666 $45193.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1855 2849 4466.581703 $223328.8600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 43 51 214.642853 $5366.0700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 7 137.857142 $6892.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 832 1501 20917.795246 $1045889.8400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 15 15 181.571428 $2178.8600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 83 735.714287 $52941.9900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 3 4 29.714286 $1711.5400 $57.6000
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 20.285714 $1168.4600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 23 35 287.999999 $20724.5000 $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 93 143 1673.571429 $120430.2600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.571429 $400.9200 $71.9600
TRAV -TRAVS Travel by mile 52 85 1209.396826 $538.1800 $0.4500
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Subtotal (Total Children Is Unduplicated) 2371 7671 35359.261043 $1758140.9800 $49.7200
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Total 8101 35758.708668 $1775524.2700 $49.6500
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Number of Children (Unduplicated) With at Least One Authorization 2409