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: 01-01-25 and 03-31-25                  Date of Report: 04-06-25                  Page: 1

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 331 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          3            3.044445           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        3          3            3.044445           $0.0000            $0.0000


Screening, Eval, and Assessment, Class # 02
 OCTH  -97165       OT EVAL LOW COMPLEXITY                       1          1            1.000000          $58.1100           $58.1100
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                        1          1            1.000000          $58.1100           $58.1100


EI Services, Class # 03
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                 123        148          351.866667       $17593.3400           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   74         79          222.366670       $11118.3500           $50.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   37         42          107.133334        $5356.6700           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                  49         50          128.033333        $6401.6700           $50.0000
 CONSP -CONSP       CONSULT, SLP, PHONE                          2          2            2.933333          $73.3300           $25.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF             5          5           27.047618        $1460.5800           $54.0000
 SPL   -92507       SPL THERAPY SESSION BY LICENSED SLP          1          1            3.533333         $287.3300           $81.3200
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      145        327          842.914288       $42291.2600           $50.1700


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Total                                                                     331          846.958733       $42349.3700           $50.0000
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Number of Children (Unduplicated) With at Least One Authorization      148