     Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period                                             Statewide

    This report estimates subtotals of units and fees for the number of days of overlap between each included
    FSPSA record and the user-selected report period.  For example, if the FSPSA record authorizes services from
    01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
    authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01).  Note that service authorization periods
    may range from 1 to 12 months and may vary in intensity from child to child.

    FSPSAs overlapping: 07/01/08 and 09/30/08                  Date of Report: 11-18-08                  Page: 1

    Eligibility Filter: Program Patients

    Services  Cpt Code                                       Number of   Number of   Total Units    Total Fees        Avg Fee
                                                             Children    Records     Overlapping    Overlapping     Per Unit Auth
                                                                                    Report Period  Report Period

    Service Coordination, Class # 01
     CASE  -CASE      NON-TCM CASE MANAGEMENT                      2          2            1.43          $52.83           $37.00
     IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN         570        573          651.56           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  24         28           42.14        $1559.29           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    26         26           32.15        $1189.41           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                        1          1            1.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    611        630          728.27        $2801.53            $3.85

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                   73         81           96.30        $4670.33           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                    13         13           17.74         $639.76           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY             105        108          108.00        $1146.96           $10.62
     AUDE  -92553     PURE TONE AUDIOMETRY AIR & BONE              1          1            1.00          $16.30           $16.30
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)           104        107          107.00         $944.81            $8.83
     AUDE  -92557     COMP AUDIO THRESHOLD EVAL/SPCH RECO          1          1            1.00          $27.10           $27.10
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)           105        108          108.00        $1166.40           $10.80
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY            103        106          106.00        $2309.74           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   5          6            6.00         $326.28           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)             97         99           99.00        $2799.72           $28.28
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  361        392          436.69       $26201.63           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  47         54           57.76        $2702.95           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             255        266          326.13       $39005.63          $119.60
     BEHV  -90801     PSYCHIATRIC DIAG INTERVIEW                   2          2            2.00         $250.00          $125.00
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                        6          7           18.00        $2250.00          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT           73         75          172.23       $21528.29          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   322        361          404.47       $20223.25           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                      116        136          175.04        $8751.79           $50.00
     FANE  -FANE      FAMILY INTERVIEW BY COMMUNITY PROVI         20         20           20.00         $600.00           $30.00
     IPDEF -IPDEF     FOLLOW-UP PSYCH AND DEV EVAL                 3          3            2.56         $192.08           $75.00
     IPDEF -IPDEF_NM  F/U PSYCH & DEV EVAL BY NON-MED PRO          2          2            2.50         $138.75           $55.50
     IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT              23         23           29.86        $2239.28           $75.00
     IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT                 4          4            5.00         $375.00           $75.00
     IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT                 9          9           12.27         $920.42           $75.00
     IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF           26         26           33.00        $2475.00           $75.00
     IPDEF -T1024TS   F/U PSYCH AND DEV EVAL BY ITDS              68         69           90.86        $5042.57           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         35         35           39.50        $2192.25           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT         546        546          760.07       $57005.36           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           129        131          191.00       $14325.00           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           175        177          261.53       $19615.00           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS         481        494          747.07       $41462.47           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR        517        573          781.93       $58644.64           $75.00
     MED   -99205     OUTPATIENT VISIT, NEW, 60 MINS               1          1            1.00          $72.78           $72.78
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 3          3            3.00         $450.00          $150.00
     NUTR  -97803     NUTRITIONAL EVAL, FOLLOW-UP                  1          1            1.00          $50.00           $50.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 4          4            4.00         $200.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          208        235          280.70       $13614.18           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL           1028       1137         1242.97       $60283.89           $48.50
     PSTF  -97002     EVAL BY LICENSED PT, FOLLOW-UP             226        264          273.84       $13281.11           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL               782        869          925.13       $44868.92           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 38         38           38.00        $1900.00           $50.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               2203       2502         2670.31      $129510.06           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 3          3            3.00         $300.00          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                14         14           26.14        $1307.15           $50.00
     WHEELP-97001TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            1.00          $48.50           $48.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   5180       9107        10689.59      $606075.33           $56.70

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       209        253          423.00      $634500.00         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               2          2            2.02         $139.25           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              1          1            1.02          $70.39           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         224        253          536.01       $26800.32           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE           893       1898         3631.45      $181572.50           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                 44         52           75.96        $1898.88           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                2426       2985         5993.88      $299693.90           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                       186        199          388.81        $9720.29           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                 1165       1425         2508.60      $125430.18           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          62         63           94.22        $2355.49           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                  851       1044         1851.28       $92564.03           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          55         61          116.53        $2913.21           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                2503       2995         5397.78      $269889.09           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                        210        227          381.29        $9532.22           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   81         85          279.64       $20531.32           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   23         26         3161.86       $39523.21           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF              5          5           11.10         $277.50           $25.00
     EIGF  -T1024TTHN *EI GROUP SESSION BY PROF                    1          1            1.77          $44.17           $25.00
     EIGF  -T1027TTSC EI GROUP SESSION BY EI PROF                563        710         4360.15      $109003.63           $25.00
     EIIF  -90801     PSYCHIATRIC DIAG INTERVIEW                   1          1           10.71         $535.72           $50.00
     EIIF  -96154     HEALTH AND BEHAVIOR INTERVENTION            20         24          330.86       $16542.86           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       7          7           30.23        $1511.59           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         33         35          289.57       $14478.59           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF              26         26          159.23        $7961.67           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF           14         15          145.90        $3647.62           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          6525       8525        65289.73     $3264486.48           $50.00
     HERN  -EIIF_NM   EI HEARING SERVICES AFTER SHINE NON          1          1           13.14         $657.15           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE             56         62          302.67       $15133.58           $50.00
     INTR  -INTR      INTERPRETER                                103        125          789.17       $39458.26           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 3489       4644        29737.39     $2018573.93           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      273        314         2172.48      $118009.11           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 3667       4937        30666.17     $2081619.74           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      302        332         2613.65      $141973.53           $54.32
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                  160        165          540.02         $540.02            $1.00
     SENS  -FM        FM RECEIVER HEARING AID                      5          5            5.00        $8250.00         $1650.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                 40         44           60.00       $30000.00          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               25         26           16.56         $712.04           $43.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           2          2            2.00         $228.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL            13         15           42.00        $9959.04          $237.12
     SENS  -V5264     EARMOLD                                     99        108          160.85        $3011.13           $18.72
     SHIN  -EIIF_NM   INITIAL SHINE SERVICES, IND NONMED           1          2           13.14         $657.14           $50.00
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL          92        122          488.20       $24410.01           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             2          2           11.43         $571.43           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       7392       9802        65425.16     $4441059.83           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             20         22          163.43        $8877.44           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                560        621         4929.08       $65063.86           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       21         25          121.35       $12135.25          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       4587       7650       741839.84      $370919.87            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               2          2           65.71        $3285.72           $50.00
     VISN  -T1024HN   *EI VISION SERVICES, INDIVIDUAL              1          1            2.50         $125.00           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL             122        170          948.25       $47412.43           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  13868      50117       976601.79    $14578267.57           $14.93

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                 59854       988019.66    $15187144.42           $15.37
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  14363