Summary Report for FSPSAs Ending During the Report Period                                             Center: 09

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: 01/01/08 and 12/31/08                  Date of Report: 02-16-09                  Page: 1

         Payor Filter: PARH   PAHM   DEI    DEIM         
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
 IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN         229        229          229.00           $0.00            $0.00
                                                         --------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                    229        229          229.00           $0.00            $0.00


Screening, Eval, and Assessment, Class # 02
 OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL              2          2            3.00         $145.50           $48.50
 PSTH  -97001     EVAL BY LICENSED PT, INITIAL                 3          3            3.00         $145.50           $48.50
 SPCH  -92506     SPEECH EVAL BY LICENSED SLP                  1          1            1.00          $48.50           $48.50
                                                         --------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      5          6            7.00         $339.50           $48.50


EI Services, Class # 03
 CONIF -CONIF     CONSULT ITDS, FACE TO FACE                   2          2            2.00         $100.00           $50.00
 CONOF -CONOF     CONSULT, OT, FACE TO FACE                    2          4            4.00         $200.00           $50.00
 CONSF -CONSF     CONSULT, SLP, FACE TO FACE                   2          2            2.00         $100.00           $50.00
 EIIF  -COUN      UNSPECIFIED COUNSELING                       3          3           30.00        $1500.00           $50.00
 EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF              14         14          126.43        $6321.43           $50.00
 OCCT  -97530     OT SESSION BY LICENSED OT                    2          2           14.57         $989.11           $67.88
 PHY   -97110     PT SESSION BY LICENSED PT                    5          5           35.29        $2395.19           $67.88
 SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP          7          7           87.07        $5910.09           $67.88
                                                         --------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                     27         39          301.35       $17515.81           $58.12


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Total                                                                   274          537.35       $17855.31           $33.23
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Number of Children (Unduplicated) With at Least One Authorization  233