Summary Report for FSPSAs Initiated During the Report Period                                             Center: 03

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: 07-01-19 and 09-30-19                  Date of Report: 11-04-19                  Page: 1

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 757 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                  40         41           32.953969           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       40         41           32.953969           $0.0000            $0.0000


Screening, Eval, and Assessment, Class # 02
 ASTE  -ASTE        ASSISTIVE TECHNOLOGY EVAL                   22         25           16.360425         $793.4800           $48.5000
 PSTH  -97163       PT EVAL HIGH COMPLEXITY                      4          4            2.525875         $128.9500           $51.0500
 SPCH  -92523       EVAL OF SPCH SOUND PROD; EVAL LANG           3          4            1.977778         $100.9700           $51.0500
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       29         33           20.864078        $1023.3900           $49.0500


EI Services, Class # 03
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                 197        242          305.603177       $15280.1800           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   92        111          109.888886        $5494.4300           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   79         92          133.015878        $6650.8200           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                 179        206          202.161900       $10108.0800           $50.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            17         20          108.301588        $5415.0800           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                    1          1            6.428571         $459.2600           $71.4400
 PHY   -97110       PT SESSION BY LICENSED PT                    4          5            7.738097         $552.8200           $71.4400
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP          5          6           45.533334        $3252.8900           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      284        683          918.671431       $47213.5400           $51.3900


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Total                                                                     757          972.489478       $48236.9400           $49.6000
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Number of Children (Unduplicated) With at Least One Authorization      325