     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

    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         282        282          291.67           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  22         24           19.43         $718.86           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                     8          8            6.84         $253.02           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                        3          3            3.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    309        317          320.94         $971.88            $3.03

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                   42         46           49.86        $2418.07           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                     7          7            6.34         $228.84           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY             100        101          101.00        $1072.62           $10.62
     AUDE  -92553     PURE TONE AUDIOMETRY AIR & BONE              1          2            2.00          $32.60           $16.30
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)            97         98           98.00         $865.34            $8.83
     AUDE  -92557     COMP AUDIO THRESHOLD EVAL/SPCH RECO          2          2            2.00          $54.20           $27.10
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)            97         98           98.00        $1058.40           $10.80
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY             94         95           95.00        $2070.05           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   1          1            1.00          $54.38           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)             86         87           87.00        $2460.36           $28.28
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  208        222          222.79       $13367.34           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  38         38           36.02        $1685.58           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             137        138          172.61       $20644.62          $119.60
     BEHV  -90801     PSYCHIATRIC DIAG INTERVIEW                   2          2            2.00         $250.00          $125.00
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                        4          4            4.00         $500.00          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT           27         27           40.62        $5076.98          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   115        124          128.33        $6416.59           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                       85         96          148.54        $7426.79           $50.00
     FANE  -FANE      FAMILY INTERVIEW BY COMMUNITY PROVI          6          6            6.00         $180.00           $30.00
     IPDEF -IPDEF     FOLLOW-UP PSYCH AND DEV EVAL                 3          3            3.50         $262.50           $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              34         34           49.07        $3680.36           $75.00
     IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT                 6          6            9.50         $712.50           $75.00
     IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT                 6          6           10.50         $787.50           $75.00
     IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF           10         10           14.07        $1055.36           $75.00
     IPDEF -T1024TS   F/U PSYCH AND DEV EVAL BY ITDS              43         44           62.00        $3441.00           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         22         22           28.00        $1554.00           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT         497        500          743.43       $55757.15           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           102        102          147.50       $11062.50           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           150        151          242.64       $18198.22           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS         440        440          674.32       $37424.72           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR        430        488          738.36       $55376.79           $75.00
     MED   -99205     OUTPATIENT VISIT, NEW, 60 MINS               4          4            6.00         $436.68           $72.78
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 1          1            1.00         $150.00          $150.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 3          4            4.00         $200.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          116        122          120.41        $5839.90           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL            536        572          599.79       $29089.88           $48.50
     PSTF  -97002     EVAL BY LICENSED PT, FOLLOW-UP             117        131          141.25        $6850.55           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL               388        401          440.09       $21344.24           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 26         26           26.00        $1300.00           $50.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               1131       1202         1268.54       $61524.22           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 2          2            2.00         $200.00          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                 8          8           14.57         $728.57           $50.00
     WHEELP-97001TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            1.00          $48.50           $48.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   3296       5475         6649.64      $382943.37           $57.59

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       126        144          214.71      $322071.45         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               1          1            0.47          $32.14           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              1          1            0.86          $58.92           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         126        128          220.93       $11046.55           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE           632        948         1638.01       $81900.60           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                 47         51           53.72        $1342.98           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                1109       1176         1950.62       $97531.09           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                        65         70           99.87        $2496.66           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                  580        617          885.97       $44298.25           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          25         26           31.84         $796.04           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                  363        382          583.82       $29190.96           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          33         34           59.76        $1493.90           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                1174       1268         1835.64       $91781.82           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                         96        104          137.42        $3435.39           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   31         31          104.86        $7698.89           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                    9          9          325.00        $4062.50           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF              3          3            2.57          $64.17           $25.00
     EIGF  -T1027TTSC EI GROUP SESSION BY EI PROF                284        302         2697.05       $67426.32           $25.00
     EIIF  -96154     HEALTH AND BEHAVIOR INTERVENTION             8          8           70.14        $3507.14           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       3          3            7.06         $353.10           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         13         13          101.86        $5092.86           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF               4          4           11.14         $557.15           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF            8          8           56.14        $1403.57           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          3257       3590        20909.81     $1045490.56           $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             33         36          135.86        $6792.89           $50.00
     INTR  -INTR      INTERPRETER                                 65         69          300.85       $15042.73           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 1919       2153        10554.55      $716442.69           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      123        129          682.14       $37053.99           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 1937       2145         9969.16      $676706.84           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      138        140          754.82       $41001.89           $54.32
     RSPT  -RSPT      RESPITE                                      1          1           49.07           $0.00            $0.00
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                  136        140          328.81         $328.81            $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                 27         27           34.50       $17250.00          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               13         13            8.33         $541.73           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           2          2            3.00         $342.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL             8          8           55.14       $13075.48          $237.12
     SENS  -V5264     EARMOLD                                     60         60           83.72        $1567.28           $18.72
     SHIN  -EIIF_NM   INITIAL SHINE SERVICES, IND NONMED           1          2            7.57         $378.57           $50.00
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL          44         47          214.34       $10717.02           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       3994       4537        23367.56     $1586190.16           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             11         11           43.91        $2385.04           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                246        250         1820.24       $24027.18           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                        8          8           25.30        $2530.47          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       2439       3389       237713.26      $118856.62            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               2          2           31.57        $1578.58           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL              59         64          285.66       $14283.13           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   8123      22159       318472.78     $5116833.22           $16.07

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                 27951       325443.37     $5500748.47           $16.90
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  9255