     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

    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         530        572          611.34           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  92        107          179.71        $6649.43           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    40         40           81.90        $3030.36           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                       18         18           18.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    614        740          895.31        $9840.83           $10.99

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                  129        164          203.58        $9873.65           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                    36         36           55.86        $2014.77           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY             312        347          503.00        $5341.86           $10.62
     AUDE  -92553     PURE TONE AUDIOMETRY AIR & BONE              5          6            6.00          $97.80           $16.30
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)           280        305          305.00        $2693.15            $8.83
     AUDE  -92557     COMP AUDIO THRESHOLD EVAL/SPCH RECO          5          5            5.00         $135.50           $27.10
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)           282        308          309.00        $3337.20           $10.80
     AUDE  -92568     ACOUSTIC REFLEX TESTING (MEMR)               1          1            1.00           $8.44            $8.44
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY            272        299          299.00        $6515.21           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   9         10           10.00         $543.80           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)            250        273          274.00        $7748.72           $28.28
     AUDE  -92588     OTOACOUSTIC EMISSIONS (COMP)                 1          1            1.00          $31.81           $31.81
     AUDE  -92682     CONDITIONED PLAY AUDIOMETRY                  2          2            2.00          $42.68           $21.34
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  678        815         1263.88       $75832.81           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  96        127          138.91        $6501.04           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             523        556          732.81       $87643.49          $119.60
     BEHV  -90801     PSYCHIATRIC DIAG INTERVIEW                   3          3           13.29        $1660.71          $125.00
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                       17         17           20.70        $2587.50          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT          121        126          415.05       $51881.29          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   819        986         1328.04       $66402.07           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                      273        305          409.07       $20453.58           $50.00
     FANE  -FANE      FAMILY INTERVIEW BY COMMUNITY PROVI         65         65           65.00        $1950.00           $30.00
     IPDEF -IPDEF     FOLLOW-UP PSYCH AND DEV EVAL                19         20           25.50        $1912.50           $75.00
     IPDEF -IPDEF_NM  F/U PSYCH & DEV EVAL BY NON-MED PRO          3          3            4.00         $222.00           $55.50
     IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT              98        101          135.48       $10161.20           $75.00
     IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT                14         14           17.51        $1312.92           $75.00
     IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT                20         20           30.23        $2267.09           $75.00
     IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF           90         92          118.57        $8892.86           $75.00
     IPDEF -T1024TS   F/U PSYCH AND DEV EVAL BY ITDS             208        221          284.91       $15812.57           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         93         93          114.50        $6354.75           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT        1828       1846         2641.21      $198091.09           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           434        440          606.71       $45503.57           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           524        528          772.60       $57945.36           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS        1666       1697         2495.00      $138472.25           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR       1879       2095         2933.20      $219990.37           $75.00
     MED   -99205     OUTPATIENT VISIT, NEW, 60 MINS               9         10           12.00         $873.36           $72.78
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 5          5            5.00         $750.00          $150.00
     NURS  -NURS      NURSING ASSESSMENT                           4          4            2.80         $140.00           $50.00
     NUTR  -97803     NUTRITIONAL EVAL, FOLLOW-UP                  2          2            1.50          $75.00           $50.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 6          7            7.00         $350.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          400        548          671.38       $32562.17           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL           1908       2257         2666.90      $129344.45           $48.50
     PSTF  -97002     EVAL BY LICENSED PT, FOLLOW-UP             395        569          630.48       $30578.05           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL              1358       1592         1779.40       $86301.11           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 98         98           97.73        $4886.67           $50.00
     SENS  -V5014TS   HEARING AID REPAIR IN-OFFICE                 1          1            1.00          $15.00           $15.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               4023       5081         5861.11      $284263.71           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 6          6           15.47        $1546.67          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                18         21           47.71        $2385.72           $50.00
     WHEELP-97001TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            1.00          $48.50           $48.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  10788      22129        28341.10     $1634355.99           $57.67

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       432        574          876.30     $1314457.20         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               3          5            9.21         $634.28           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              3          3            3.98         $273.90           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         396        474         1494.22       $74710.79           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE          1842       4019         7539.55      $376977.47           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                105        123          222.32        $5557.92           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                3515       4938        16511.58      $825578.78           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                       277        311         1241.07       $31026.86           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                 1718       2457         6777.10      $338854.95           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                         100        114          322.11        $8052.77           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                 1187       1678         4817.73      $240886.74           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          80        101          340.15        $8503.69           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                3767       5124        15360.38      $768019.11           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                        351        401         1275.34       $31883.43           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   85         92          613.52       $45044.32           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   31         34        10093.71      $126171.43           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF             19         22           80.57        $2014.16           $25.00
     EIGF  -T1027TTSC EI GROUP SESSION BY EI PROF                876       1231        16400.50      $410012.52           $25.00
     EIIF  -90801     PSYCHIATRIC DIAG INTERVIEW                   1          1           23.86        $1192.86           $50.00
     EIIF  -96154     HEALTH AND BEHAVIOR INTERVENTION            26         34         1002.57       $50128.58           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       6          6           16.76         $838.02           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         82        101         1765.43       $88271.45           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF               1          1            5.86         $292.86           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF           21         25          361.70        $9042.62           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          9328      14480       210629.29    $10531464.52           $50.00
     HERN  -EIIF_NM   EI HEARING SERVICES AFTER SHINE NON          2          2           33.25        $1662.38           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE             97        151         1359.55       $67977.58           $50.00
     INTR  -INTR      INTERPRETER                                205        296         2525.59      $126279.75           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 4909       8305        95273.96     $6467196.44           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      463        556         7142.47      $387978.95           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 4823       8288        96820.39     $6572167.88           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      456        522         7182.86      $390172.69           $54.32
     RSPT  -RSPT      RESPITE                                      1          1          103.47           $0.00            $0.00
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                  483        519         1706.84        $1706.84            $1.00
     SENS  -FM        FM RECEIVER HEARING AID                     15         15           16.00       $26400.00         $1650.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                 75         84          121.72       $60861.10          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               34         38           36.40        $2366.23           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           6          6            8.00         $912.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL            30         34          117.14       $27776.92          $237.12
     SENS  -V5264     EARMOLD                                    165        217          446.49        $8358.38           $18.72
     SHIN  -EIIF_NM   INITIAL SHINE SERVICES, IND NONMED           1          2           26.43        $1321.43           $50.00
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL         142        206         1591.21       $79560.53           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             3          3           39.29        $1964.29           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP      10573      17473       207111.08    $14058700.04           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             30         36          483.91       $26285.83           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                960       1102        16573.55      $218770.86           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       43         66          315.31       $31530.50          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       6817      13592      2296154.66     $1148077.29            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               2          2          145.14        $7257.14           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL             160        275         2849.69      $142484.25           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  19582      88140      3035969.20    $45147660.48           $14.87

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                111009      3065205.60    $46791857.30           $15.27
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  20871