Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 01/01/08 and 12/31/08 Date of Report: 02-16-09 Page: 1
Payor Filter: PARH PAHM DEI DEIM
Eligibility Filter: Program Patients
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
EI Services, Class # 03
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 209.14 $5228.57 $25.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 2.73 $648.12 $237.12
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2 2 3.21 $1.61 $0.50
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Subtotal (Total Children Is Unduplicated) 4 4 215.09 $5878.30 $27.33
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Total 4 215.09 $5878.30 $27.33
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Number of Children (Unduplicated) With at Least One Authorization 4