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: 10-01-22 and 12-31-22                  Date of Report: 01-23-23                  Page: 1

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 398 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                   3          4            1.300000           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        3          4            1.300000           $0.0000            $0.0000


EI Services, Class # 03
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                 134        162          387.357137       $19367.8300           $50.0000
 CONIF -CONIFGT     CONSULT,ITDS,FACE TO FACE                    2          2            7.666666         $383.3300           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   84        101          268.823812       $13441.2000           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   37         40          126.966667        $6348.3400           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                  82         85          209.533334       $10476.6700           $50.0000
 CONSP -CONSP       CONSULT, SLP, PHONE                          3          3            4.366667         $109.1700           $25.0000
 INTR  -T1013       INTERPRETER                                  1          1            1.000000          $50.0000           $50.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      161        394         1005.714283       $50176.5300           $49.8900


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Total                                                                     398         1007.014283       $50176.5300           $49.8300
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Number of Children (Unduplicated) With at Least One Authorization      164