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

This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending between: 01-01-16 and 03-31-16                  Date of Report: 05-12-16                  Page: 1

Eligibility Filter: Program Patients
   
With the filters selected there were 262 FSPSA's found of which 17 had no frequency modifier field, FORCE FREQ MODIFIER to 0


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                   1          2            2.066666           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        1          2            2.066666           $0.0000            $0.0000


EI Services, Class # 03
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE            45         61            4.652729         $232.6600           $50.0000
 COIFP -COIFP       IFSP CONSULT, PROF, BY PHONE                 2          2            0.006850           $0.1700           $24.8200
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                   8         14            0.934123          $46.6900           $49.9800
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                   2          3            0.072222           $3.6100           $49.9800
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            42         44          159.538094        $7976.9000           $50.0000
 INTR  -T1013       INTERPRETER                                  9          9          182.714286        $9135.7200           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                   11         16           45.809524        $3272.6500           $71.4400
 PHY   -97110       PT SESSION BY LICENSED PT                   17         18           76.085716        $5435.5600           $71.4400
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP         41         45          221.123810       $15797.0800           $71.4400
 TRAV  -A0160       *PROV TRAVEL TO NATURAL ENV-BY MIN          40         48          164.719046          $82.3600            $0.5000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      132        260          855.656400       $41983.3800           $49.0700


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Total                                                                     262          857.723066       $41983.3800           $48.9500
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Number of Children (Unduplicated) With at Least One Authorization      133