Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 Page: 1
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
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 0.633333 $31.6700 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 40 40 23.135717 $1156.8000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 2 2 0.700000 $17.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 15 15 6.183334 $309.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 13 5.111904 $255.6000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 23 23 10.650001 $532.5100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 2.757143 $68.9300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 50 50 114.426191 $5721.3200 $50.0000
INTR -INTR INTERPRETER 2 2 5.142857 $257.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 13 25.999999 $1764.8800 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 10 10 13.342857 $905.7200 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 25 68.857140 $4674.0300 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.285714 $30.1700 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 88 149 15613.428574 $7806.7200 $0.5000
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Subtotal (Total Children Is Unduplicated) 91 351 15892.821431 $23536.3000 $1.4800
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Total 351 15892.821431 $23536.3000 $1.4800
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Number of Children (Unduplicated) With at Least One Authorization 91