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

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: 04-01-25 and 06-30-25                  Date of Report: 07-19-25                  Page: 1

    Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
   
With the filters selected there were 354 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                  10         10            8.144444           $0.0000            $0.0000
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                       10         10            8.144444           $0.0000            $0.0000


EI Services, Class # 03
 COIFF -COIFF       IFSP CONSULT, PROF, FACE TO FACE             2          2            4.133333         $206.6700           $50.0000
 CONIF -CONIF       CONSULT, ITDS FACE TO FACE                 130        150          405.383338       $20269.1900           $50.0000
 CONIF -CONIFGT     CONSULT, ITDS, TELEMEDICINE                  1          1            1.000000          $50.0000           $50.0000
 CONOF -CONOF       CONSULT, OT, FACE TO FACE                   72         78          218.200002       $10910.0100           $50.0000
 CONOP -CONOP       CONSULT, OT, PHONE                           1          1            2.733333          $68.3300           $25.0000
 CONPF -CONPF       CONSULT, PT, FACE TO FACE                   32         37          108.966667        $5448.3400           $50.0000
 CONSF -CONSF       CONSULT, SLP, FACE TO FACE                  59         63          179.266670        $8963.3500           $50.0000
 CONSP -CONSP       CONSULT, SLP, PHONE                          2          2            2.166667          $54.1700           $25.0000
 EIIF  -T1027SC     EI INDIVIDUAL SESSION BY EI PROF             7          8           38.923808        $2101.8900           $54.0000
 INTR  -T1013       INTERPRETER                                  1          1           13.000000         $650.0000           $50.0000
 OCCT  -97530       OT SESSION BY LICENSED OT                    1          1            1.857143         $151.0200           $81.3200
                                                         ----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      150        344          975.630961       $48872.9500           $50.0900


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Total                                                                     354          983.775405       $48872.9500           $49.6800
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Number of Children (Unduplicated) With at Least One Authorization      160