Summary Report for FSPSAs Initiated During the Report Period                                             Center: 57

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 748 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
 TCM   -T1017TL     TARGETED CASE MANAGEMENT                     6          6            4.999999         $185.0000           $37.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        6          6            4.999999         $185.0000           $37.0000


EI Services, Class # 03
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE             1          2            0.300000          $15.0000           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                  133        136           64.049215        $3202.5000           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   27         27           17.849208         $892.4700           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                 198        201          109.000799        $5450.0600           $50.0000
 EIGF  -T1027TTSC   EI GROUP SESSION BY EI PROF                  2          2            6.142857         $153.5700           $25.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF             7          7           54.214286        $2710.7200           $50.0000
 NESF  -99600       NATURAL ENVIRONMENT SUPPORT FEE            348        361         2274.315866       $22743.1600           $10.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                    3          3            4.214285         $301.0800           $71.4400
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP          3          3            4.214285         $301.0800           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      355        742         2534.300801       $35769.6200           $14.1100


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Total                                                                     748         2539.300800       $35954.6200           $14.1600
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Number of Children (Unduplicated) With at Least One Authorization      359