Summary Report for FSPSAs Ending During the Report Period                                             Center: 52

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 415 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



Screening, Eval, and Assessment, Class # 02
 EVAL  -96111       DEVELOPMENTAL EVALUATION                     1          1            1.000000          $50.0000           $50.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        1          1            1.000000          $50.0000           $50.0000


EI Services, Class # 03
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE             3          4            4.500000         $225.0000           $50.0000
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                 125        150          348.849995       $17442.4800           $50.0000
 CONIP -CONIP       CONSULT, ITDS PHONE                          1          1            1.000000          $25.0000           $25.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   75         88          220.500004       $11025.0200           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   50         51          113.733339        $5686.7000           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                 105        109          235.500000       $11775.0000           $50.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF             5          6           19.523809         $976.1900           $50.0000
 INTR  -T1013       INTERPRETER                                  2          2            9.342857         $467.1500           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                    2          2            1.500000         $107.1600           $71.4400
 OCCT  -97530HMGT   OT SESSION BY OT ASST                        1          1            5.571429         $318.6800           $57.2000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      158        414          960.021433       $48048.3600           $50.0500


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Total                                                                     415          961.021433       $48098.3600           $50.0500
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Number of Children (Unduplicated) With at Least One Authorization      158