     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

    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
     CASE  -CASE      NON-TCM CASE MANAGEMENT                      3          3            4.35         $161.04           $37.00
     IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN         741        780         1064.45           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  35         40           91.00        $3367.00           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    35         35           68.09        $2519.23           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                       13         13           13.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    796        871         1240.89        $6047.27            $4.87

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                   90        123          150.86        $7316.57           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                     8          9           11.39         $410.80           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY             174        195          277.00        $2941.74           $10.62
     AUDE  -92553     PURE TONE AUDIOMETRY AIR & BONE              1          1            1.00          $16.30           $16.30
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)           154        170          170.00        $1501.10            $8.83
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)           155        171          171.00        $1846.80           $10.80
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY            148        165          165.00        $3595.35           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   4          5            5.00         $271.90           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)            140        155          155.00        $4383.40           $28.28
     AUDE  -92588     OTOACOUSTIC EMISSIONS (COMP)                 1          1            1.00          $31.81           $31.81
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  374        444          665.72       $39943.22           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  33         43           48.36        $2263.04           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             236        248          322.08       $38520.59          $119.60
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                        8          8            8.00        $1000.00          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT           48         51          191.45       $23931.38          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   536        696          860.49       $43024.25           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                      128        140          187.68        $9383.93           $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         14           17.50        $1312.50           $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              57         57           74.48        $5586.20           $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             123        127          167.72        $9308.59           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         33         33           36.00        $1998.00           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT         870        877         1249.57       $93717.86           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           202        205          276.50       $20737.50           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           309        311          439.68       $32975.72           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS         962        980         1388.42       $77057.53           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR        995       1105         1532.78      $114958.23           $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          198        272          367.92       $17843.88           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL            899       1045         1231.16       $59711.46           $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             235        304          362.49       $17580.94           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL               777        887         1056.49       $51239.78           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 30         30           33.00        $1650.00           $50.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               1727       2090         2367.43      $114820.36           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 3          3            3.00         $300.00          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                19         23           62.20        $3109.77           $50.00
     WHEELO-97003TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            5.00         $242.50           $48.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   5518      11117        14223.21      $816022.75           $57.37

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       182        238          334.62      $501928.50         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               2          3            4.51         $310.63           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              3          4            3.93         $270.85           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         150        173          587.87       $29393.31           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE           853       1619         2980.59      $149029.57           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                 45         52          115.60        $2890.12           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                1719       2617         9261.50      $463075.01           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                       133        148          700.39       $17509.86           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                  878       1323         3876.56      $193828.22           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          46         52          136.93        $3423.25           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                  699       1034         3134.97      $156748.28           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          42         50          146.47        $3661.78           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                1645       2361         7509.36      $375467.84           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                        185        212          809.06       $20226.56           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   45         49          437.00       $32084.42           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   35         43         8635.57      $107944.64           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF             12         12           54.03        $1350.83           $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                452        669         8362.48      $209061.89           $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            10         10          258.80       $12940.00           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       5          6           25.26        $1262.78           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         49         62         1071.14       $53557.14           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF            1008       1028         8699.67      $434983.73           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF           15         16          272.28        $6806.91           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          4487       6845       111400.24     $5570012.03           $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             47         78          835.31       $41765.55           $50.00
     INTR  -INTR      INTERPRETER                                144        210         2089.74      $104487.23           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 2459       4058        49171.56     $3337765.57           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      254        284         4153.94      $225642.24           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 2858       4735        57689.39     $3915955.88           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      292        329         4941.64      $268429.98           $54.32
     RSPT  -RSPT      RESPITE                                      1          1          103.47           $0.00            $0.00
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                  117        123          800.08         $800.08            $1.00
     SENS  -FM        FM RECEIVER HEARING AID                      3          3            3.00        $4950.00         $1650.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                 12         16           24.50       $12250.00          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               13         17           16.47        $1070.81           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           2          2            3.00         $342.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL            16         17           25.17        $5967.50          $237.12
     SENS  -V5264     EARMOLD                                     56         71          167.33        $3132.36           $18.72
     SHIN  -T1024HN   *INITIAL SHINE SERVICES, INDIVIDUAL          4          4           24.08        $1203.81           $50.00
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL          81        127          929.94       $46496.95           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             1          1           22.29        $1114.29           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       4533       7277        87262.25     $5923361.66           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             46         46          422.16       $22931.56           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                403        476         7761.63      $102453.53           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       29         44          170.77       $17077.17          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       3401       6612       971600.42      $485800.18            $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              81        144         1578.64       $78932.25           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   9858      43425      1360740.34    $23016811.84           $16.91

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                 55413      1376204.44    $23838881.87           $17.32
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  11063