Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period                                             Center: 52

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                



Screening, Eval, and Assessment, Class # 02
 OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL              1          1            0.866667          $42.0400           $48.5000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      1          1            0.866667          $42.0400           $48.5000


EI Services, Class # 03
 ASST  -ASST      ASSISTIVE TECHNOLOGY                         1          1            1.022222        $1533.3000         $1499.9700
 CONIF -CONIF     CONSULT ITDS, FACE TO FACE                  24         25           12.100002         $605.0100           $50.0000
 CONOF -CONOF     CONSULT, OT, FACE TO FACE                    9          9            2.833334         $141.6700           $50.0000
 CONPF -CONPF     CONSULT, PT, FACE TO FACE                   10         10            6.066667         $303.3400           $50.0000
 CONSF -CONSF     CONSULT, SLP, FACE TO FACE                  26         26           12.833335         $641.6800           $50.0000
 EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF             1          1            3.714286         $185.7200           $50.0000
 SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP          1          1            0.600000          $40.7300           $67.8800
 TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM         42         73        12636.285716        $6318.1400            $0.5000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                     47        146        12675.455562        $9769.5800            $0.7700


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Total                                                                   147        12676.322229        $9811.6100            $0.7700
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Number of Children (Unduplicated) With at Least One Authorization  47