     Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period                                             Statewide

    This report estimates subtotals of units and fees for the number of days of overlap between each included
    FSPSA record and the user-selected report period.  For example, if the FSPSA record authorizes services from
    01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
    authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01).  Note that service authorization periods
    may range from 1 to 12 months and may vary in intensity from child to child.

    FSPSAs overlapping: 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 Fees        Avg Fee
                                                             Children    Records     Overlapping    Overlapping     Per Unit Auth
                                                                                    Report Period  Report Period

    Service Coordination, Class # 01
     CASE  -CASE      NON-TCM CASE MANAGEMENT                      3          3            4.35         $161.04           $37.00
     IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN        1596       1684         2330.75           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  93        108          180.71        $6686.43           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    52         53          102.69        $3799.60           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                       18         18           18.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   1688       1866         2636.51       $10647.06            $4.04

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                  153        203          242.58       $11765.15           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                    38         39           61.25        $2209.14           $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)           284        310          310.31        $3351.36           $10.80
     AUDE  -92568     ACOUSTIC REFLEX TESTING (MEMR)               1          1            1.00           $8.44            $8.44
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY            273        300          299.31        $6521.99           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                  10         12           12.00         $652.56           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)            250        273          274.00        $7748.72           $28.28
     AUDE  -92588     OTOACOUSTIC EMISSIONS (COMP)                 2          2            2.00          $63.62           $31.81
     AUDE  -92682     CONDITIONED PLAY AUDIOMETRY                  2          2            2.00          $42.68           $21.34
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  764        922         1400.80       $84047.84           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                 100        135          147.41        $6898.84           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             624        672          857.38      $102542.23          $119.60
     BEHV  -90801     PSYCHIATRIC DIAG INTERVIEW                   3          3           13.29        $1660.71          $125.00
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                       24         24           52.84        $6605.35          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT          144        152          548.04       $68505.49          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                  1030       1328         1728.86       $86443.23           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                      275        307          411.07       $20553.58           $50.00
     FANE  -FANE      FAMILY INTERVIEW BY COMMUNITY PROVI         72         72           86.00        $2580.00           $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                21         21           31.23        $2342.09           $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             210        223          287.72       $15968.59           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         94         94          115.50        $6410.25           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT        1841       1859         2661.64      $199623.23           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           437        443          612.43       $45932.15           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           530        534          778.60       $58395.36           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS        1680       1711         2509.00      $139249.25           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR       1883       2099         2937.20      $220290.37           $75.00
     MED   -99205     OUTPATIENT VISIT, NEW, 60 MINS               9         10           12.00         $873.36           $72.78
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 6          6            6.00         $900.00          $150.00
     NURS  -NURS      NURSING ASSESSMENT                           4          4            2.80         $140.00           $50.00
     NUTR  -97803     NUTRITIONAL EVAL, FOLLOW-UP                  3          3            2.27         $113.34           $50.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                10         11           11.00         $550.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          493        711          883.05       $42827.77           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL           2285       2725         3181.05      $154281.11           $48.50
     PDEO  -T1024     *PSY-DEV EVAL OUTPATIENT, INITIAL            8          8           14.77        $2215.49          $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             498        754          849.40       $41195.75           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL              1670       1992         2281.89      $110671.78           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                101        101          106.73        $5336.67           $50.00
     SENS  -V5014TS   HEARING AID REPAIR IN-OFFICE                 1          1            1.00          $15.00           $15.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               4674       6086         7223.66      $350347.51           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 7          7           16.47        $1646.67          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                23         28           67.20        $3359.77           $50.00
     WHEELO-97003TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            5.00         $242.50           $48.50
     WHEELP-97001TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            1.00          $48.50           $48.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  11993      25085        32169.49     $1846049.28           $57.39

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       481        643          995.79     $1493690.40         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               3          6           10.93         $752.87           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              5          6            9.01         $620.50           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         463        578         1858.68       $92934.11           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE          1937       4385         8319.85      $415992.43           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                119        138          266.91        $6672.71           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                4076       6336        20335.71     $1016785.68           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                       353        400         1630.21       $40755.25           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                 2041       3183         8452.01      $422600.50           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                         131        150          436.94       $10923.51           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                 1440       2292         6243.49      $312174.35           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          89        115          392.39        $9809.76           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                4393       6485        18950.74      $947536.85           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                        496        576         1997.88       $49947.04           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                  122        133         1008.06       $74011.63           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   50         62        14016.71      $175208.93           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF             21         24           91.37        $2284.16           $25.00
     EIGF  -T1024TTHN *EI GROUP SESSION BY PROF                  131        132         2260.62       $56515.39           $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                954       1411        19293.84      $482345.97           $25.00
     EIIF  -90801     PSYCHIATRIC DIAG INTERVIEW                   1          1           23.86        $1192.86           $50.00
     EIIF  -90812     INDIVIDUAL PSYCHOTHERAPY, 45-50 MIN          1          1            3.77         $188.34           $50.00
     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            36         44         1234.09       $61704.30           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                      15         16          116.23        $5811.59           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO        106        144         2240.57      $112028.60           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF            1782       1831        16029.61      $801480.36           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF           28         32          457.70       $11442.62           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF         10303      17059       251620.49    $12581024.32           $50.00
     HERN  -EIIF_NM   EI HEARING SERVICES AFTER SHINE NON          2          3           41.82        $2090.95           $50.00
     HERN  -T1024HN   *EI HEARING SERVICES AFTER SHINE            22         22          246.56       $12328.09           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE            110        181         1671.99       $83599.47           $50.00
     INTR  -INTR      INTERPRETER                                222        331         3138.14      $156906.76           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 5875      10812       121545.55     $8250512.21           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      633        769         9997.32      $543054.15           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 5826      10995       126174.22     $8564706.29           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      658        778        10722.22      $582430.72           $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                     17         17           21.43       $35357.19         $1650.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                 81         94          134.72       $67361.10          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               35         44           43.88        $2852.40           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           6          6            8.00         $912.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL            35         40          124.54       $29531.59          $237.12
     SENS  -V5264     EARMOLD                                    184        252          535.53       $10025.21           $18.72
     SHIN  -EIIF_NM   INITIAL SHINE SERVICES, IND NONMED           1          2           26.43        $1321.43           $50.00
     SHIN  -T1024HN   *INITIAL SHINE SERVICES, INDIVIDUAL          8          8           56.59        $2829.29           $50.00
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL         158        243         1833.89       $91694.70           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             4          4           42.14        $2107.14           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP      12556      22192       257856.23    $17503281.13           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             94        102          920.67       $50010.85           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD               1234       1487        22595.64      $298262.39           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       51         80          376.67       $37667.17          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       7705      16367      2400890.49     $1200445.19            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               3          3          153.71        $7685.71           $50.00
     VISN  -T1024HN   *EI VISION SERVICES, INDIVIDUAL             41         41          386.04       $19302.04           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL             177        320         3366.12      $168306.07           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  22729     111900      3343049.31    $56913710.54           $17.02

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                138851      3377855.31    $58770406.89           $17.40
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  23957