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: 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 914 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
 OCTH  -97167       OT EVAL HIGH COMPLEXITY                      5          5            2.311111         $117.9800           $51.0500
 SPCH  -92523       EVAL OF SPCH SOUND PROD; EVAL LANG           5          5            2.311111         $117.9800           $51.0500
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        5         10            4.622222         $235.9600           $51.0500


EI Services, Class # 03
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE             2          5            0.888890          $44.4500           $50.0100
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                  190        193          184.380160        $9219.0200           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   36         37          108.579365        $5428.9700           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                 253        257          193.438093        $9671.9100           $50.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF             7          7           35.714285        $1785.7200           $50.0000
 NESF  -99600       NATURAL ENVIRONMENT SUPPORT FEE            395        403         2764.223774       $27642.2600           $10.0000
 PHY   -97110       PT SESSION BY LICENSED PT                    1          1            9.142857         $653.1700           $71.4400
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP          1          1            9.142857         $653.1700           $71.4400
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      397        904         3305.510281       $55098.6500           $16.6700


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Total                                                                     914         3310.132503       $55334.6200           $16.7200
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Number of Children (Unduplicated) With at Least One Authorization      401