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

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 106 FSPSA's found 


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                   7          8            9.487301           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        7          8            9.487301           $0.0000            $0.0000


EI Services, Class # 03
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE            37         46           24.451176        $1222.5800           $50.0000
 COIFP -COIFP       IFSP CONSULT, PROF, BY PHONE                12         12            3.102434          $77.5700           $25.0000
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                   6          7            0.222220          $11.1000           $49.9500
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                    4          5            0.166665           $8.3300           $49.9500
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                   3          3            0.255555          $12.7800           $49.9900
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF             5          5           36.642856        $1832.1500           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                    3          3            7.785715         $556.2100           $71.4400
 PHY   -97110       PT SESSION BY LICENSED PT                    6          6           24.885714        $1777.8400           $71.4400
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP         11         11           53.714284        $3837.3600           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       59         98          151.226619        $9335.8900           $61.7300


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Total                                                                     106          160.713920        $9335.8900           $58.0900
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Number of Children (Unduplicated) With at Least One Authorization      63