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: 01-01-13 and 03-31-13                  Date of Report: 05-17-13                  Page: 1

    Child has a MEDICAID # Filter: Y
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                    2          2            0.828571           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      2          2            0.828571           $0.0000            $0.0000


EI Services, Class # 03
 AUD   -HA_FUP    AUDIOLOGY SERVICES                           2          2            2.888889         $144.4500           $50.0000
 CONIF -CONIF     CONSULT ITDS, FACE TO FACE                 562        609          892.276179       $44613.7600           $50.0000
 CONOF -CONOF     CONSULT, OT, FACE TO FACE                  563        604          890.981733       $44549.0200           $50.0000
 CONPF -CONPF     CONSULT, PT, FACE TO FACE                  565        605          892.442845       $44622.0800           $50.0000
 CONSF -CONSF     CONSULT, SLP, FACE TO FACE                 563        608          882.796018       $44139.7400           $50.0000
 EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF             7          9           47.357144        $2367.8600           $50.0000
 OCCT  -97530     OT SESSION BY LICENSED OT                    5          6           36.457143        $2474.7100           $67.8800
 PHY   -97110     PT SESSION BY LICENSED PT                    2          2           16.714286        $1134.5700           $67.8800
 SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL           1          1            0.622222          $31.1100           $50.0000
 SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP          7          7           42.902381        $2912.2100           $67.8800
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                    567       2453         3705.438840      $186989.4900           $50.4600


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Total                                                                  2455         3706.267411      $186989.4900           $50.4500
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Number of Children (Unduplicated) With at Least One Authorization  568