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

Eligibility Filter: Program Patients
   
With the filters selected there were 454 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                  34         34           69.498411           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       35         35           71.465078          $72.7700            $1.0200


EI Services, Class # 03
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE            61         95          153.344444        $7667.2200           $50.0000
 COIFP -COIFP       IFSP CONSULT, PROF, BY PHONE                21         27           25.247466         $631.1900           $25.0000
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                  29         31           35.615873        $1780.7900           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   27         27           25.677778        $1283.8900           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   13         13           11.300000         $565.0000           $50.0000
 CONPP -CONPP       CONSULT, PT, PHONE                           1          1            1.000000          $25.0000           $25.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                  31         32           36.643651        $1832.1800           $50.0000
 CONSP -CONSP       CONSULT, SLP, PHONE                          1          1            1.000000          $25.0000           $25.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            97        101          680.119043       $34006.0000           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                   19         20          145.085714       $10364.9300           $71.4400
 PHY   -97110       PT SESSION BY LICENSED PT                   11         11           96.142855        $6868.4600           $71.4400
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP         56         60          480.899997       $34355.5000           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      236        419         1692.076821       $99405.1400           $58.7500


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Total                                                                     454         1763.541899       $99477.9100           $56.4100
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Number of Children (Unduplicated) With at Least One Authorization      271