Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period                                             Center: 09

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                



Service Coordination, Class # 01
 IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN         123        123          123.00           $0.00            $0.00
                                                         --------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                    123        123          123.00           $0.00            $0.00


Screening, Eval, and Assessment, Class # 02
 PSTH  -97001     EVAL BY LICENSED PT, INITIAL                 2          2            2.00          $97.00           $48.50
                                                         --------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      2          2            2.00          $97.00           $48.50


EI Services, Class # 03
 EIIF  -COUN      UNSPECIFIED COUNSELING                       1          1           10.00         $500.00           $50.00
 EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF               7          7           51.57        $2578.58           $50.00
 PHY   -97110     PT SESSION BY LICENSED PT                    1          1           11.57         $785.47           $67.88
 SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP          1          1           20.43        $1386.69           $67.88
                                                         --------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                     10         10           93.57        $5250.74           $56.11


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Total                                                                   135          218.57        $5347.74           $24.47
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Number of Children (Unduplicated) With at Least One Authorization  125