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: 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 297 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                  27         28           14.211114           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       27         28           14.211114           $0.0000            $0.0000


Screening, Eval, and Assessment, Class # 02
 ASTE  -ASTE        ASSISTIVE TECHNOLOGY EVAL                   11         11            7.878615         $382.1100           $48.5000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       11         11            7.878615         $382.1100           $48.5000


EI Services, Class # 03
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                   7         10            7.244445         $362.2300           $50.0000
 CONIF -CONIFGT     CONSULT,ITDS,FACE TO FACE                    1          1            1.822222          $91.1100           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   55         63           93.542854        $4677.1300           $50.0000
 CONOF -CONOFGT     CONSULT,OT,FACE TO FACE                      3          3            6.711110         $335.5500           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   44         52           40.966668        $2048.3400           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                  95        104          109.550797        $5477.5600           $50.0000
 CONSF -CONSFGT     CONSULT,SLP,FACE TO FACE                     5          7            5.711110         $285.5500           $50.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            16         17           89.377778        $4468.9000           $50.0000
 PHY   -97110       PT SESSION BY LICENSED PT                    1          1            1.133333          $80.9600           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      179        258          356.060317       $17827.3200           $50.0700


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Total                                                                     297          378.150046       $18209.4400           $48.1500
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Number of Children (Unduplicated) With at Least One Authorization      210