     Summary Report for FSPSAs Ending During the Report Period                                             Statewide

    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: 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 Cost of        Avg Fee
                                                             Children    Records     Authorized   Auth Services     Per Unit Auth

    Service Coordination, Class # 01
     CASE  -CASE      NON-TCM CASE MANAGEMENT                      2          2            1.43          $52.83           $37.00
     IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN         270        270          264.86           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  22         26           28.00        $1036.00           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    15         15           16.81         $621.92           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                        1          1            1.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    305        314          312.10        $1710.75            $5.48

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                   47         49           52.15        $2529.40           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                     3          3            3.00         $108.21           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY             105        108          108.00        $1146.96           $10.62
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)           102        105          105.00         $927.15            $8.83
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)           104        107          107.00        $1155.60           $10.80
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY            101        104          104.00        $2266.16           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   4          4            4.00         $217.52           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)             97         99           99.00        $2799.72           $28.28
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  198        214          238.59       $14315.47           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  24         26           30.09        $1408.16           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             134        136          155.61       $18610.71          $119.60
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                        2          2            2.00         $250.00          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT           40         41           63.92        $7990.59          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   133        140          139.23        $6961.67           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                       93        105          132.04        $6601.79           $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          1          1            1.50          $83.25           $55.50
     IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT              20         20           26.86        $2014.28           $75.00
     IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT                 2          2            2.00         $150.00           $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              58         59           76.86        $4265.57           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         20         20           23.50        $1304.25           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT         507        507          707.36       $53051.79           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           122        124          183.00       $13725.00           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           158        160          238.53       $17890.00           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS         473        486          726.36       $40312.82           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR        484        540          743.43       $55757.14           $75.00
     MED   -99205     OUTPATIENT VISIT, NEW, 60 MINS               1          1            1.00          $72.78           $72.78
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 2          2            2.00         $300.00          $150.00
     NUTR  -97803     NUTRITIONAL EVAL, FOLLOW-UP                  1          1            1.00          $50.00           $50.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 1          1            1.00          $50.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          103        106          130.76        $6341.76           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL            512        530          564.20       $27363.62           $48.50
     PSTF  -97002     EVAL BY LICENSED PT, FOLLOW-UP             122        127          124.97        $6060.88           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL               351        368          365.53       $17728.43           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 27         27           27.00        $1350.00           $50.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               1044       1104         1141.27       $55351.66           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 1          1            1.00         $100.00          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                 8          8            8.00         $400.00           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   3238       5496         6508.59      $375199.83           $57.65

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       131        149          272.00      $408000.00         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               1          1            1.00          $68.86           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         100        105          185.81        $9290.48           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE           679       1086         1888.56       $94428.22           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                 32         36           38.63         $965.84           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                1083       1188         2126.15      $106307.55           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                        99        101          155.67        $3891.73           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                  551        601          913.01       $45650.66           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          24         24           33.69         $842.23           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                  396        416          699.72       $34985.85           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          19         20           29.31         $732.64           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                1112       1204         1829.58       $91479.22           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                         97        102          143.40        $3584.99           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   31         32          120.16        $8821.95           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   11         11         1016.71       $12708.93           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF              3          3            4.97         $124.17           $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                267        310         1631.34       $40783.57           $25.00
     EIIF  -96154     HEALTH AND BEHAVIOR INTERVENTION             8          9          166.57        $8328.57           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       4          4           13.00         $650.00           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         18         18          108.14        $5407.14           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF              22         22          118.80        $5940.24           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF            8          8           57.23        $1430.71           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          3155       3573        22086.11     $1104305.41           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE             16         17           92.95        $4647.38           $50.00
     INTR  -INTR      INTERPRETER                                 56         59          320.44       $16022.15           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 1831       2113        10355.42      $702925.80           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      142        148          766.01       $41609.81           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 1884       2153        10534.11      $715055.52           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      124        130          801.67       $43546.93           $54.32
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                   23         23           20.11          $20.11            $1.00
     SENS  -FM        FM RECEIVER HEARING AID                      3          3            3.00        $4950.00         $1650.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                 19         19           29.00       $14500.00          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR                9          9            8.88         $381.92           $43.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           2          2            2.00         $228.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL             8          8           12.00        $2845.44          $237.12
     SENS  -V5264     EARMOLD                                     42         44           64.01        $1198.21           $18.72
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL          46         58          160.41        $8020.72           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             2          2           11.43         $571.43           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       3795       4361        23181.12     $1573534.32           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST              8          9           62.57        $3398.88           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                263        281         1725.81       $22780.65           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       14         17           67.57        $6757.14          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       2341       3285       233460.32      $116730.16            $0.50
     VISN  -T1024HN   *EI VISION SERVICES, INDIVIDUAL              1          1            2.50         $125.00           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL              66         84          331.47       $16573.64           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   7677      21850       315654.15     $5285196.30           $16.74

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                 27660       322474.83     $5662106.88           $17.56
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  8835