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

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: 01-01-20 and 03-31-20                  Date of Report: 05-15-20                  Page: 1

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 624 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                  55         56           27.559522           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       55         56           27.559522           $0.0000            $0.0000


Screening, Eval, and Assessment, Class # 02
 ASTE  -ASTE        ASSISTIVE TECHNOLOGY EVAL                   15         16           10.783334         $523.0000           $48.5000
 PSTH  -97163       PT EVAL HIGH COMPLEXITY                      4          4            2.938888         $150.0300           $51.0500
 SPCH  -92523       EVAL OF SPCH SOUND PROD; EVAL LANG           1          1            0.394444          $20.1300           $51.0400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       18         21           14.116666         $693.1500           $49.1000


EI Services, Class # 03
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                 158        170          194.026995        $9701.4100           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   83         94           97.961114        $4898.0700           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   63         68           69.138095        $3456.9000           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                 163        178          160.157939        $8007.9100           $50.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            24         26          100.309520        $5015.4900           $50.0000
 INTR  -T1013       INTERPRETER                                  1          1            3.285714         $164.2900           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                    1          1            0.214286          $15.3100           $71.4400
 PHY   -97110       PT SESSION BY LICENSED PT                    5          5           16.542857        $1181.8200           $71.4400
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP          4          4           20.857143        $1490.0400           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      247        547          662.493663       $33931.2300           $51.2200


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Total                                                                     624          704.169851       $34624.3800           $49.1700
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Number of Children (Unduplicated) With at Least One Authorization      303