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: 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 172 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
 CASE  -CASE        NON-TCM CASE MANAGEMENT                      1          1            1.966667          $72.7700           $37.0000
 SCONLY-SCONLY      *SERVICE COORDINATION ONLY                  24         24           45.912696           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       25         25           47.879363          $72.7700            $1.5200


EI Services, Class # 03
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE            42         64           99.844444        $4992.2200           $50.0000
 COIFP -COIFP       IFSP CONSULT, PROF, BY PHONE                15         19           18.225244         $455.6300           $25.0000
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                  14         16           16.211111         $810.5600           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   16         16           15.238889         $761.9500           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   12         12           10.300000         $515.0000           $50.0000
 CONPP -CONPP       CONSULT, PT, PHONE                           1          1            1.000000          $25.0000           $25.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                  12         13           14.000000         $700.0000           $50.0000
 CONSP -CONSP       CONSULT, SLP, PHONE                          1          1            1.000000          $25.0000           $25.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF             3          3           17.428571         $871.4300           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                    2          2            3.004762         $214.6600           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       83        147          196.253021        $9371.4400           $47.7500


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Total                                                                     172          244.132384        $9444.2100           $38.6800
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Number of Children (Unduplicated) With at Least One Authorization      108