     Summary Report for FSPSAs Initiated During the Report Period                                             Statewide

    This report shows the total number of units/fees for FSPSAs initiated during the report period.
    (i.e., start 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 starting 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         262        281          296.23           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  35         40          103.57        $3832.14           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    27         27           55.50        $2053.40           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                       13         13           13.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    309        364          472.65        $6046.58           $12.79

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                   90        118          147.86        $7171.07           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                    21         21           39.86        $1437.65           $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          5            5.00         $271.90           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)            140        156          156.00        $4411.68           $28.28
     AUDE  -92682     CONDITIONED PLAY AUDIOMETRY                  1          1            1.00          $21.34           $21.34
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  396        482          724.33       $43460.05           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  38         54           61.39        $2873.00           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             257        272          343.92       $41132.63          $119.60
     BEHV  -90801     PSYCHIATRIC DIAG INTERVIEW                   1          1           11.29        $1410.71          $125.00
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                       11         11           14.70        $1837.50          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT           69         72          249.45       $31181.38          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   447        550          783.91       $39195.48           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                      142        155          212.68       $10633.93           $50.00
     FANE  -FANE      FAMILY INTERVIEW BY COMMUNITY PROVI         20         20           20.00         $600.00           $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                16         16           24.23        $1817.09           $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             125        129          168.91        $9374.57           $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         884        892         1281.57       $96117.86           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           206        209          285.50       $21412.50           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           318        320          459.68       $34475.72           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS         974        993         1418.42       $78722.53           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR        998       1108         1538.28      $115370.73           $75.00
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 2          2            2.00         $300.00          $150.00
     NUTR  -97803     NUTRITIONAL EVAL, FOLLOW-UP                  1          1            1.00          $50.00           $50.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 3          3            3.00         $150.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          172        241          366.09       $17755.39           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL            947       1123         1416.10       $68680.92           $48.50
     PSTF  -97002     EVAL BY LICENSED PT, FOLLOW-UP             197        256          288.79       $14006.30           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL               799        932         1084.78       $52611.86           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 31         31           31.00        $1550.00           $50.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               1918       2323         2719.11      $131876.61           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 4          4            9.00         $900.00          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                15         17           43.71        $2185.72           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   5632      11412        14936.61      $859366.00           $57.53

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       174        235          327.62      $491428.50         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               2          3            3.34         $230.30           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              2          2            1.93         $133.13           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         152        178          604.98       $30248.80           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE           870       1817         3333.56      $166677.95           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                 41         49          101.40        $2535.12           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                1940       2758         9477.05      $473852.57           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                       133        148          572.92       $14322.89           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                  940       1344         3855.85      $192792.34           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          49         54          125.93        $3148.34           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                  729       1014         3119.54      $155976.99           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          52         61          160.86        $4021.49           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                1914       2604         7721.55      $386077.74           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                        164        188          544.47       $13611.64           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   41         44          322.89       $23706.77           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   21         22         7036.29       $87953.57           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF             14         14           58.97        $1474.16           $25.00
     EIGF  -T1027TTSC EI GROUP SESSION BY EI PROF                523        752         9000.35      $225008.86           $25.00
     EIIF  -96154     HEALTH AND BEHAVIOR INTERVENTION             8          9          291.14       $14557.14           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       2          2            2.19         $109.45           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         49         57         1073.00       $53650.01           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF               1          1            5.86         $292.86           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF           12         15          229.13        $5728.34           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          5361       8213       119078.68     $5953934.09           $50.00
     HERN  -EIIF_NM   EI HEARING SERVICES AFTER SHINE NON          1          1           30.71        $1535.72           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE             58         95          884.77       $44238.41           $50.00
     INTR  -INTR      INTERPRETER                                171        243         2108.28      $105413.91           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 2486       3987        46979.57     $3188972.97           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      231        269         3603.68      $195751.65           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 2847       4713        56327.79     $3823530.57           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      266        294         3819.13      $207455.06           $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                 16         20           29.50       $14750.00          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               21         24           18.84        $1224.49           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           2          2            3.00         $342.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL            18         20           34.00        $8062.08          $237.12
     SENS  -V5264     EARMOLD                                     67         91          208.12        $3896.10           $18.72
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL          97        147         1001.47       $50073.62           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             1          1           22.29        $1114.29           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       4875       7659        89987.35     $6108341.53           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             14         14          206.09       $11194.83           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                421        466         6944.84       $91671.85           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       28         41          162.22       $16222.39          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       3837       7537      1262188.54      $631094.24            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               2          2          145.14        $7257.14           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL              94        165         1662.95       $83147.58           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  10452      45749      1644825.19    $22904663.32           $13.93

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                 57525      1660234.45    $23770075.90           $14.32
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  11173