     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: 10/01/08 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 Cost of        Avg Fee
                                                             Children    Records     Authorized   Auth Services     Per Unit Auth

    Service Coordination, Class # 01
     IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN         144        144          131.94           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                   5          5            5.43         $200.86           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                     5          5            5.66         $209.55           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                        3          3            3.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    155        157          146.03         $410.40            $2.81

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                   26         28           31.86        $1545.07           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                     3          3            2.34          $84.56           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY              58         58           58.00         $615.96           $10.62
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)            56         56           56.00         $494.48            $8.83
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)            55         55           55.00         $594.00           $10.80
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY             52         52           52.00        $1133.08           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   1          1            1.00          $54.38           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)             51         51           51.00        $1442.28           $28.28
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  126        132          136.57        $8194.34           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  16         16           15.03         $703.56           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID              63         63           70.52        $8433.79          $119.60
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                        3          3            3.00         $375.00          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT            9          9            8.04        $1005.55          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                    88         96           98.86        $4943.14           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                       48         55           87.04        $4351.79           $50.00
     IPDEF -IPDEF     FOLLOW-UP PSYCH AND DEV EVAL                 2          2            2.00         $150.00           $75.00
     IPDEF -IPDEF_NM  F/U PSYCH & DEV EVAL BY NON-MED PRO          1          1            1.00          $55.50           $55.50
     IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT              14         14           18.57        $1392.86           $75.00
     IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT                 4          4            6.00         $450.00           $75.00
     IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT                 4          4            7.00         $525.00           $75.00
     IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF            4          4            4.57         $342.86           $75.00
     IPDEF -T1024TS   F/U PSYCH AND DEV EVAL BY ITDS              22         22           33.00        $1831.50           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED          7          7            8.00         $444.00           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT         244        244          368.00       $27600.00           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT            46         46           64.50        $4837.50           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT            95         96          157.64       $11823.22           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS         269        269          400.89       $22249.42           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR        224        245          364.36       $27326.79           $75.00
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 1          1            1.00         $150.00          $150.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 1          1            1.00          $50.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP           54         56           55.07        $2670.96           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL            279        301          307.59       $14918.26           $48.50
     PSTF  -97002     EVAL BY LICENSED PT, FOLLOW-UP              51         54           54.00        $2619.00           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL               221        226          260.01       $12610.51           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                  7          7            7.00         $350.00           $50.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP                530        553          586.55       $28447.79           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 1          1            1.00         $100.00          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                 6          6           12.57         $628.57           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   1720       2842         3447.60      $195544.69           $56.72

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                        53         62           70.00      $105000.00         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               1          1            0.47          $32.14           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                          54         54           98.07        $4903.38           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE           288        443          753.14       $37657.03           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                 16         18           17.12         $427.92           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                 618        647         1052.73       $52636.39           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                        35         38           48.00        $1200.12           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                  321        338          494.41       $24720.32           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          13         14           11.91         $297.71           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                  219        226          354.38       $17718.93           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          22         23           22.58         $564.38           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                 604        646          917.61       $45880.63           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                         47         53           62.03        $1550.86           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   12         12           24.71        $1814.47           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                    6          6          297.57        $3719.64           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF              2          2            1.67          $41.67           $25.00
     EIGF  -T1027TTSC EI GROUP SESSION BY EI PROF                174        186         1086.26       $27156.56           $25.00
     EIIF  -96154     HEALTH AND BEHAVIOR INTERVENTION             2          2            6.86         $342.86           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       1          1            0.57          $28.34           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         11         11           88.86        $4442.86           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF               2          2            6.43         $321.43           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF            4          4           20.14         $503.57           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          1861       2036        11428.78      $571438.80           $50.00
     HERN  -EIIF_NM   EI HEARING SERVICES AFTER SHINE NON          1          1            0.14           $7.15           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE             20         23          101.93        $5096.53           $50.00
     INTR  -INTR      INTERPRETER                                 50         53          253.68       $12683.93           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                  971       1086         5286.65      $358857.57           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                       61         64          305.68       $16604.59           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 1097       1213         5525.15      $375047.34           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                       76         76          374.21       $20327.05           $54.32
     RSPT  -RSPT      RESPITE                                      1          1           49.07           $0.00            $0.00
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                   96         98          231.83         $231.83            $1.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                  6          6            7.50        $3750.00          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR                8          8            5.66         $368.10           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           2          2            3.00         $342.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL             7          7           14.00        $3319.68          $237.12
     SENS  -V5264     EARMOLD                                     26         26           36.49         $683.07           $18.72
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL          30         31          104.50        $5225.12           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       1775       2000         9802.33      $665381.99           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST              2          2           13.29         $721.68           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                 99        101          740.60        $9775.90           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                        4          4            8.39         $838.57          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       1343       1857       127077.29       $63538.64            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               2          2           31.57        $1578.58           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL              37         40          220.86       $11043.09           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   4188      11526       167058.09     $2457822.34           $14.71

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                 14525       170651.72     $2653777.43           $15.55
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  4808