Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 04-01-13 and 06-30-13 Date of Report: 08-18-13 Page: 1
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
SCONLY-SCONLY SERVICE COORDINATION ONLY 1 1 2.071429 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 2.071429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 0.211111 $10.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.211111 $10.5600 $50.0000
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 0.714286 $35.7200 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 23 125 63.329164 $3166.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 3.033333 $151.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 6.661904 $333.1000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 1.199999 $60.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1 1 0.266667 $13.3400 $50.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 3.000000 $195.0000 $65.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 39 119 8632.752381 $4316.3800 $0.5000
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Subtotal (Total Children Is Unduplicated) 45 265 8710.957734 $8271.6300 $0.9500
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Total 267 8713.240274 $8282.1800 $0.9500
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Number of Children (Unduplicated) With at Least One Authorization 45