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
 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            16         16           32.464287        $1623.2200           $50.0000
 INTR  -INTR      INTERPRETER                                  2          2            5.142857         $257.1500           $50.0000
 OCCT  -97530     OT SESSION BY LICENSED OT                    4          4            7.428571         $504.2500           $67.8800
 PHY   -97110     PT SESSION BY LICENSED PT                    5          5            6.200000         $420.8600           $67.8800
 SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP         10         10           26.499998        $1798.8300           $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
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                     89        287        15742.154767       $14785.8500            $0.9400


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Total                                                                   287        15742.154767       $14785.8500            $0.9400
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Number of Children (Unduplicated) With at Least One Authorization  89