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: 10-01-14 and 12-31-14 Date of Report: 01-12-15 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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1 1 6.142857 $307.1500 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 4.285714 $290.9100 $67.8800
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Subtotal (Total Children Is Unduplicated) 3 3 10.428571 $598.0600 $57.3500
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Total 3 10.428571 $598.0600 $57.3500
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Number of Children (Unduplicated) With at Least One Authorization 3