Summary Report for FSPSAs Initiated During the Report Period                                             Center: 09

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

Eligibility Filter: Program Patients
   
With the filters selected there were 560 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                  28         28           44.742859           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       28         28           44.742859           $0.0000            $0.0000


EI Services, Class # 03
 ASST  -ASST        ASSISTIVE TECHNOLOGY                         1          1            1.000000        $5000.0000         $5000.0000
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE            73        124          177.447544        $8872.3800           $50.0000
 COIFP -COIFP       IFSP CONSULT, PROF, BY PHONE                54         73           85.585317        $2139.6300           $25.0000
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                  35         36           34.485714        $1724.2900           $50.0000
 CONIP -CONIP       CONSULT, ITDS PHONE                          1          1            1.000000          $25.0000           $25.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   33         34           59.711111        $2985.5600           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   22         23           24.646902        $1232.3500           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                  44         44           50.379443        $2518.9800           $50.0000
 CONSP -CONSP       CONSULT, SLP, PHONE                          1          1            1.000000          $25.0000           $25.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            88         93          537.552383       $26877.5900           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                   21         22          147.838095       $10561.5500           $71.4400
 PHY   -97110       PT SESSION BY LICENSED PT                   22         24          146.742856       $10483.3200           $71.4400
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP         50         56          354.000000       $25289.7600           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      271        532         1621.389365       $97735.3800           $60.2800


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Total                                                                     560         1666.132224       $97735.3800           $58.6600
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Number of Children (Unduplicated) With at Least One Authorization      299