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: 04-01-20 and 06-30-20                  Date of Report: 07-20-20                  Page: 1

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 484 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                  54         55           29.134389           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       54         55           29.134389           $0.0000            $0.0000


Screening, Eval, and Assessment, Class # 02
 ASTE  -ASTE        ASSISTIVE TECHNOLOGY EVAL                   19         23           17.674124         $857.1900           $48.5000
 PSTH  -97163       PT EVAL HIGH COMPLEXITY                      2          2            2.000000         $102.1000           $51.0500
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       21         25           19.674124         $959.2900           $48.7600


EI Services, Class # 03
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                  85         86           74.455560        $3722.8000           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   74         81           98.461113        $4923.0700           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   61         67           86.336513        $4316.8500           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                 138        140          120.115083        $6005.7800           $50.0000
 CONSF -CONSFGT     CONSULT,SLP,FACE TO FACE                     2          2            0.800000          $40.0000           $50.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            25         26          124.495238        $6224.7500           $50.0000
 PHY   -97110       PT SESSION BY LICENSED PT                    2          2            2.676190         $191.1900           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      233        404          507.339697       $25424.4300           $50.1100


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Total                                                                     484          556.148210       $26383.7200           $47.4400
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Number of Children (Unduplicated) With at Least One Authorization      293