Summary Report for FSPSAs Initiated During the Report Period                                             Center: 09

This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.

FSPSAs starting between: 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 Cost of          Avg Fee
                                                         Children    Records         Authorized     Auth Services       Per Unit Auth



Service Coordination, Class # 01
 SCONLY-SCONLY    SERVICE COORDINATION ONLY                    3          3            7.238095           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      3          3            7.238095           $0.0000            $0.0000


EI Services, Class # 03
 CONIF -CONIF     CONSULT ITDS, FACE TO FACE                 833        906         1571.629370       $78581.4900           $50.0000
 CONOF -CONOF     CONSULT, OT, FACE TO FACE                  836        894         1482.219053       $74110.9800           $50.0000
 CONPF -CONPF     CONSULT, PT, FACE TO FACE                  830        880         1449.173021       $72458.6700           $50.0000
 CONSF -CONSF     CONSULT, SLP, FACE TO FACE                 827        900         1444.360320       $72218.0300           $50.0000
 EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF           164        182         1167.842869       $58392.1300           $50.0000
 OCCT  -97530     OT SESSION BY LICENSED OT                    9         11           35.963493        $2441.2000           $67.8800
 PHY   -97110     PT SESSION BY LICENSED PT                    4          4           38.857143        $2637.6300           $67.8800
 SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL           2          2            0.477778          $23.8900           $50.0000
 SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP         20         24          145.377781        $9868.2500           $67.8800
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                    860       3803         7335.900828      $370732.2500           $50.5400


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Total                                                                  3806         7343.138923      $370732.2500           $50.4900
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Number of Children (Unduplicated) With at Least One Authorization  863