     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: 01/01/08 and 12/31/08                  Date of Report: 02-16-09                  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                      3          3            4.35         $161.04           $37.00
     IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN        1509       1583         2240.98           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  91        106          166.14        $6147.29           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    49         49           86.51        $3200.81           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                       18         18           18.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   1613       1759         2515.98        $9509.14            $3.78

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                  133        174          211.58       $10261.65           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                    12         13           15.39         $555.08           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY             311        345          501.00        $5320.62           $10.62
     AUDE  -92553     PURE TONE AUDIOMETRY AIR & BONE              2          3            3.00          $48.90           $16.30
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)           276        300          300.00        $2649.00            $8.83
     AUDE  -92557     COMP AUDIO THRESHOLD EVAL/SPCH RECO          4          4            4.00         $108.40           $27.10
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)           279        304          304.31        $3286.56           $10.80
     AUDE  -92568     ACOUSTIC REFLEX TESTING (MEMR)               1          1            1.00           $8.44            $8.44
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY            271        297          296.31        $6456.62           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   9         10           10.00         $543.80           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)            248        270          271.00        $7663.88           $28.28
     AUDE  -92588     OTOACOUSTIC EMISSIONS (COMP)                 1          1            1.00          $31.81           $31.81
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  655        775         1217.07       $73024.07           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  80        103          113.06        $5291.26           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             485        515          664.11       $79427.34          $119.60
     BEHV  -90801     PSYCHIATRIC DIAG INTERVIEW                   2          2            2.00         $250.00          $125.00
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                       17         17           42.14        $5267.85          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT          105        110          413.47       $51684.05          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   935       1171         1442.18       $72108.98           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                      244        274          358.07       $17903.58           $50.00
     FANE  -FANE      FAMILY INTERVIEW BY COMMUNITY PROVI         72         72           86.00        $2580.00           $30.00
     IPDEF -IPDEF     FOLLOW-UP PSYCH AND DEV EVAL                19         19           24.50        $1837.50           $75.00
     IPDEF -IPDEF_NM  F/U PSYCH & DEV EVAL BY NON-MED PRO          3          3            4.00         $222.00           $55.50
     IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT              97        100          134.48       $10086.20           $75.00
     IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT                14         14           17.51        $1312.92           $75.00
     IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT                21         21           31.23        $2342.09           $75.00
     IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF           90         92          118.57        $8892.86           $75.00
     IPDEF -T1024TS   F/U PSYCH AND DEV EVAL BY ITDS             204        217          281.72       $15635.59           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         84         84           96.50        $5355.75           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT        1805       1822         2557.64      $191823.23           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           429        435          596.43       $44732.15           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           511        515          741.60       $55620.36           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS        1645       1675         2406.00      $133532.75           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR       1877       2092         2926.70      $219502.87           $75.00
     MED   -99205     OUTPATIENT VISIT, NEW, 60 MINS               9         10           12.00         $873.36           $72.78
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 6          6            6.00         $900.00          $150.00
     NUTR  -97803     NUTRITIONAL EVAL, FOLLOW-UP                  3          3            2.27         $113.34           $50.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 9         10           10.00         $500.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          418        581          701.51       $34023.17           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL           1830       2109         2411.16      $116941.11           $48.50
     PDEO  -T1024     *PSY-DEV EVAL OUTPATIENT, INITIAL            8          8           14.77        $2215.49          $150.00
     PDFO  -T1024HTTS *PSY-DEV EVAL OUTPATIENT, FOLLOW-UP          2          2            0.68         $102.11          $150.00
     PSTF  -97002     EVAL BY LICENSED PT, FOLLOW-UP             442        635          722.91       $35061.00           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL              1316       1504         1770.72       $85880.08           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 95         95          101.00        $5050.00           $50.00
     SENS  -V5014TS   HEARING AID REPAIR IN-OFFICE                 1          1            1.00          $15.00           $15.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               3706       4662         5478.42      $265703.28           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 4          4            4.00         $400.00          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                22         27           66.20        $3309.77           $50.00
     WHEELO-97003TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            5.00         $242.50           $48.50
     WHEELP-97001TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            1.00          $48.50           $48.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  10603      21509        27502.21     $1586746.83           $57.70

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       433        559          898.39     $1347590.40         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               3          5           10.38         $714.62           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              5          6            9.01         $620.50           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         343        409         1358.24       $67911.86           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE          1813       3552         6543.46      $327173.02           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                116        133          258.43        $6460.63           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                3009       4444        15363.32      $768166.02           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                       284        312         1368.11       $34202.71           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                 1598       2351         6493.71      $324685.48           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          98        107          343.54        $8588.40           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                 1098       1632         4639.48      $231973.75           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          66         79          290.27        $7256.66           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                3217       4539        14275.71      $713785.28           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                        406        458         1727.08       $43177.10           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   94        101          851.82       $62540.75           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   42         52        10058.14      $125726.79           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF             17         18           72.53        $1813.33           $25.00
     EIGF  -T1024TTHN *EI GROUP SESSION BY PROF                  130        131         2051.47       $51286.81           $25.00
     EIGF  -T1027TTHM EI GROUP SESSION BY PARAPROF                 2          2           15.00         $187.50           $12.50
     EIGF  -T1027TTSC EI GROUP SESSION BY EI PROF                739       1057        15110.45      $377761.26           $25.00
     EIIF  -90812     INDIVIDUAL PSYCHOTHERAPY, 45-50 MIN          1          1            3.77         $188.34           $50.00
     EIIF  -90846     FAMILY PSYCHOTHERAPY W/O PATIENT             1          1            7.71         $385.72           $50.00
     EIIF  -90847     FAMILY PSYCHOTHERAPY WITH PATIENT            1          1            8.29         $414.29           $50.00
     EIIF  -96154     HEALTH AND BEHAVIOR INTERVENTION            28         30          788.80       $39440.01           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                      13         14          104.43        $5221.35           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         82        106         1662.14       $83107.15           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF            1781       1830        15925.04      $796251.79           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF           24         25          389.70        $9742.62           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          7856      12048       194565.43     $9728271.38           $50.00
     HERN  -EIIF_NM   EI HEARING SERVICES AFTER SHINE NON          1          2           39.29        $1964.29           $50.00
     HERN  -T1024HN   *EI HEARING SERVICES AFTER SHINE            22         22          246.56       $12328.09           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE             82        128         1298.88       $64943.88           $50.00
     INTR  -INTR      INTERPRETER                                179        264         2518.63      $125931.63           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 4866       8346        97252.98     $6601532.40           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      485        558         8245.04      $447870.72           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 4838       8305        98860.30     $6710636.87           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      495        577         8941.75      $485715.74           $54.32
     RSPT  -RSPT      RESPITE                                      1          1          103.47           $0.00            $0.00
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                  165        174         1087.18        $1087.18            $1.00
     SENS  -FM        FM RECEIVER HEARING AID                     12         12           15.43       $25457.19         $1650.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                 59         67           97.50       $48750.00          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               24         28           33.78        $2195.99           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           5          5            6.00         $684.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL            25         27          101.54       $24077.83          $237.12
     SENS  -V5264     EARMOLD                                    138        178          398.76        $7464.80           $18.72
     SHIN  -EIIF_NM   INITIAL SHINE SERVICES, IND NONMED           1          2           26.43        $1321.43           $50.00
     SHIN  -T1024HN   *INITIAL SHINE SERVICES, INDIVIDUAL          8          8           56.59        $2829.29           $50.00
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL         116        173         1375.63       $68781.72           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             3          3           30.29        $1514.29           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       9970      16694       202665.87    $13756959.54           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             85         90          790.14       $42920.16           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                910       1099        18447.82      $243511.28           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       42         68          318.41       $31840.51          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       6018      11765      1696833.41      $848416.67            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               3          3          153.71        $7685.71           $50.00
     VISN  -T1024HN   *EI VISION SERVICES, INDIVIDUAL             41         41          386.04       $19302.04           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL             138        235         2627.83      $131391.27           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  18654      82878      2438153.09    $44881759.96           $18.41

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                106146      2468171.28    $46478015.93           $18.83
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  20835