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: 10-01-13 and 12-31-13 Date of Report: 02-18-14 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
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 0.866667 $43.3400 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 976 1298 1971.594332 $98579.1600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 975 1279 1934.317348 $96715.3200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 976 1290 1969.016558 $98450.2900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 979 1305 1986.883223 $99343.6200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 17 23 155.714285 $7785.7300 $50.0000
INTR -INTR INTERPRETER 1 1 6.285714 $314.2900 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 2 5 15.542857 $1055.0500 $67.8800
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 2 3 1.722222 $86.1100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 5 26.424603 $1793.7100 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 76 283 34548.647619 $17274.3200 $0.5000
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Subtotal (Total Children Is Unduplicated) 981 5493 42617.015428 $421440.9100 $9.8900
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Total 5493 42617.015428 $421440.9100 $9.8900
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Number of Children (Unduplicated) With at Least One Authorization 981