Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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
Child has a MEDICAID # Filter: Y
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
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 2.00 $100.00 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 4.86 $242.86 $50.00
INTR -INTR INTERPRETER 1 1 4.86 $242.86 $50.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2 2 4.00 $2.00 $0.50
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Subtotal (Total Children Is Unduplicated) 2 5 15.71 $587.71 $37.40
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Total 5 15.71 $587.71 $37.40
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Number of Children (Unduplicated) With at Least One Authorization 2