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: 10-01-20 and 12-31-20                  Date of Report: 01-23-21                  Page: 1

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 359 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                  46         47           23.755552           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       46         47           23.755552           $0.0000            $0.0000


Screening, Eval, and Assessment, Class # 02
 ASTE  -ASTE        ASSISTIVE TECHNOLOGY EVAL                   10         11            9.391792         $455.5100           $48.5000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       10         11            9.391792         $455.5100           $48.5000


EI Services, Class # 03
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                  12         14           19.455555         $972.7800           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   63         70           83.577778        $4178.8900           $50.0000
 CONOF -CONOFGT     CONSULT,OT,FACE TO FACE                      2          2            1.255556          $62.7800           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   41         43           46.233333        $2311.6700           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                 132        141          142.812704        $7140.6600           $50.0000
 CONSF -CONSFGT     CONSULT,SLP,FACE TO FACE                     5          5            3.666666         $183.3300           $50.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            25         25           84.100001        $4205.0100           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                    1          1            0.366667          $26.2000           $71.4500
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      224        301          381.468260       $19081.3100           $50.0200


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Total                                                                     359          414.615604       $19536.8100           $47.1200
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Number of Children (Unduplicated) With at Least One Authorization      273