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

    Child has a MEDICAID # Filter: Y
    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                      3          3            4.35         $161.04           $37.00
     IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN         778        823         1102.20           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  36         41          104.57        $3869.14           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    36         37           71.64        $2650.58           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                       13         13           13.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    830        917         1295.77        $6680.76            $5.16

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                  106        146          175.86        $8529.07           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                    23         24           45.25        $1632.02           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY             174        196          278.00        $2952.36           $10.62
     AUDE  -92553     PURE TONE AUDIOMETRY AIR & BONE              2          2            2.00          $32.60           $16.30
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)           156        173          173.00        $1527.59            $8.83
     AUDE  -92557     COMP AUDIO THRESHOLD EVAL/SPCH RECO          1          1            1.00          $27.10           $27.10
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)           156        173          173.00        $1868.40           $10.80
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY            148        166          166.00        $3617.14           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   5          6            6.00         $326.28           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)            140        156          156.00        $4411.68           $28.28
     AUDE  -92588     OTOACOUSTIC EMISSIONS (COMP)                 1          1            1.00          $31.81           $31.81
     AUDE  -92682     CONDITIONED PLAY AUDIOMETRY                  1          1            1.00          $21.34           $21.34
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  438        534          780.88       $46853.08           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  39         56           63.39        $2966.60           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             312        334          413.49       $49453.37          $119.60
     BEHV  -90801     PSYCHIATRIC DIAG INTERVIEW                   1          1           11.29        $1410.71          $125.00
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                       13         13           16.70        $2087.50          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT           76         81          300.88       $37609.95          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   608        819         1102.99       $55149.65           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                      142        155          212.68       $10633.93           $50.00
     FANE  -FANE      FAMILY INTERVIEW BY COMMUNITY PROVI         23         23           27.00         $810.00           $30.00
     IPDEF -IPDEF     FOLLOW-UP PSYCH AND DEV EVAL                14         15           18.50        $1387.50           $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              58         58           75.48        $5661.20           $75.00
     IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT                 7          7            8.01         $600.42           $75.00
     IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT                17         17           25.23        $1892.09           $75.00
     IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF           60         62           78.57        $5892.86           $75.00
     IPDEF -T1024TS   F/U PSYCH AND DEV EVAL BY ITDS             127        131          171.72        $9530.59           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         39         39           48.00        $2664.00           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT         887        895         1284.57       $96342.86           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           207        210          286.50       $21487.50           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           320        322          461.68       $34625.72           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS         979        998         1423.42       $79000.03           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR       1000       1110         1540.28      $115520.73           $75.00
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 3          3            3.00         $450.00          $150.00
     NUTR  -97803     NUTRITIONAL EVAL, FOLLOW-UP                  2          2            1.77          $88.34           $50.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 6          6            6.00         $300.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          227        327          475.49       $23061.10           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL           1139       1365         1684.95       $81720.14           $48.50
     PDEO  -T1024     *PSY-DEV EVAL OUTPATIENT, INITIAL            4          4            8.10        $1215.21          $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             267        364          428.92       $20802.73           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL               993       1183         1372.72       $66576.86           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 32         32           35.00        $1750.00           $50.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               2247       2805         3302.84      $160187.64           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 5          5           10.00        $1000.00          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                20         24           63.20        $3159.77           $50.00
     WHEELO-97003TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            5.00         $242.50           $48.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   6316      13050        16929.52      $967352.80           $57.14

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       199        269          370.62      $555928.50         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               2          4            5.07         $348.89           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              3          4            3.93         $270.85           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         189        229          783.31       $39165.70           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE           915       1993         3735.36      $186767.90           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                 46         55          121.50        $3037.62           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                2263       3628        11906.53      $595326.47           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                       170        193          830.47       $20761.76           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                 1115       1766         4909.30      $245465.19           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          65         74          180.65        $4516.37           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                  896       1419         4107.07      $205353.62           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          58         71          196.73        $4918.27           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                2238       3335         9750.78      $487539.18           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                        227        265          930.26       $23256.52           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   58         64          517.10       $37965.61           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   38         47        10586.43      $132330.36           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF             15         15           64.47        $1611.66           $25.00
     EIGF  -T1024TTHN *EI GROUP SESSION BY PROF                   81         82         1542.42       $38560.51           $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                567        872        10711.48      $267786.91           $25.00
     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            14         15          370.09       $18504.29           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       6          7           25.49        $1274.45           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         62         80         1322.71       $66135.72           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF            1009       1029         8804.25      $440212.30           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF           16         19          290.28        $7256.91           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          5923       9723       143874.69     $7193734.62           $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             6          6           94.57        $4728.57           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE             66        113         1091.31       $54565.54           $50.00
     INTR  -INTR      INTERPRETER                                184        273         2680.25      $134012.36           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 3013       5289        61171.46     $4152318.98           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      325        383         5082.42      $276077.23           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 3488       6318        74206.07     $5037108.28           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      383        438         5855.07      $318047.32           $54.32
     RSPT  -RSPT      RESPITE                                      1          1          103.47           $0.00            $0.00
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                  344        369         1299.94        $1299.94            $1.00
     SENS  -FM        FM RECEIVER HEARING AID                      4          4            4.00        $6600.00         $1650.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                 18         24           35.50       $17750.00          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               22         28           23.84        $1549.49           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           2          2            3.00         $342.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL            20         23           35.17        $8338.70          $237.12
     SENS  -V5264     EARMOLD                                     75        103          236.34        $4424.21           $18.72
     SHIN  -T1024HN   *INITIAL SHINE SERVICES, INDIVIDUAL          4          4           24.08        $1203.81           $50.00
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL         109        173         1184.79       $59239.45           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             1          1           22.29        $1114.29           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       5816       9773       112493.26     $7636042.49           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             53         53          512.46       $27836.91           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                563        658         9603.67      $126768.49           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       34         51          208.92       $20891.93          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       4338       9156      1328734.49      $664367.21            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               2          2          145.14        $7257.14           $50.00
     VISN  -T1024HN   *EI VISION SERVICES, INDIVIDUAL             28         28          272.30       $13615.13           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL             106        193         2000.78      $100039.17           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  12169      58730      1823135.87    $29256520.56           $16.05

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                 72697      1841361.16    $30230554.12           $16.42
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  12874