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: 01-01-23 and 03-31-23                  Date of Report: 04-20-23                  Page: 1

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 788 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
 TCM   -T1017TL     TARGETED CASE MANAGEMENT                     4          4            2.333333          $86.8000           $37.2000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        4          4            2.333333          $86.8000           $37.2000


Screening, Eval, and Assessment, Class # 02
 PSTF  -97164       PT RE-EVAL EST PLAN CARE                     1          1            0.361111          $18.5600           $51.4100
 SPCH  -92521       EVAL OF SPEECH FLUENCY                       2          4            2.144444         $110.2400           $51.4100
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        3          5            2.505555         $128.8100           $51.4100


EI Services, Class # 03
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                  321        333          248.274605       $12413.7300           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   46         46           53.660319        $2683.0100           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                 361        374          251.390476       $12569.5300           $50.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF            14         15          105.133332        $5256.6800           $50.0000
 PHY   -97110       PT SESSION BY LICENSED PT                    1          1            9.285714         $668.2000           $71.9600
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP          1          2            3.714286         $267.2800           $71.9600
 TRAV  -TRAVS       Travel by mile                               8          8           61.000000          $27.1500            $0.4500
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      429        779          732.458732       $33885.5600           $46.2600


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Total                                                                     788          737.297620       $34101.1700           $46.2500
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Number of Children (Unduplicated) With at Least One Authorization      433