Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 17266 DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR LEGS; LESION DIAMETER $106.12 20060701 99999999 17270 DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; $57.13 20060701 99999999 17271 DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; $66.59 20060701 99999999 17272 DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; $80.14 20060701 99999999 17273 DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; $93.06 20060701 99999999 17274 DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; $117.37 20060701 99999999 17276 DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; $141.91 20060701 99999999 17280 DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCO $54.49 20060701 99999999 17281 DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCO $77.57 20060701 99999999 17282 DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCO $92.79 20060701 99999999 17283 DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCO $117.44 20060701 99999999 17284 DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCO $141.36 20060701 99999999 17286 DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCO $198.19 20060701 99999999 17304 CHEMOSURGERY (MOHS' TECHNIQUE) $298.50 20030401 99999999 17305 CHEMOSURGERY (MOHS' TECHNIQUE) $118.29 20030401 99999999 17306 CHEMOSURGERY (MOHS' TECHNIQUE) $111.12 20030401 99999999 17307 CHEMOSURGERY (MOHS' TECHNIQUE) $112.05 20030401 99999999 17310 CHEMOSURGERY (MOHS' TECHNIQUE) $34.67 20030401 99999999 17311 MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI $247.08 20070101 99999999 17312 MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI $131.50 20070101 99999999 17313 MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI $221.46 20070101 99999999 17314 MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI $121.59 20070101 99999999 17315 MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI $34.41 20070101 99999999 17340 CRYOTHERAPY (CO2 SLUSH, LIQUID N2) $27.80 20060701 99999999 17360 CHEMICAL EXFOLIATION FOR ACNE (EG, ACNE PASTE, ACID) $55.75 20060701 99999999 17999 UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE $329.32 19990701 99999999 19000 PUNCTURE ASPIRATION OF CYST OF BREAST $31.03 20060701 99999999 19001 PUNCTURE ASPIRATION OF CYST OF BREAST $15.86 20060701 99999999 19020 MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP $176.39 20060701 99999999 19030 INJECTION PROCEDURE ONLY FOR MAMMARY DUCTOGRAM OR $56.73 20060701 99999999 19100 BIOPSY OF BREAST $47.22 20060701 99999999 19101 BIOPSY OF BREAST $168.35 20060701 99999999 19102 BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, USING IMAGING GUIDANCE $105.45 20060701 99999999 19103 BIOPSY OF BREAST; PERCUTANEOUS, AUTOMATED VACUUM ASSISTED OR ROTATING BIOPSY DEV $193.12 20060701 99999999 19105 ABLATION, CRYOSURGICAL, OF FIBROADENOMA, INCLUDING ULTRASOUND GUIDANCE, EACH FIB $124.31 20070101 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 102
PROC-CODE DESC MAC BEG END 19110 NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY $231.29 20060701 99999999 19112 EXCISION OF LACTIFEROUS DUCT FISTULA $190.18 20060701 99999999 19120 EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR $263.34 20060701 99999999 19125 EXCISION OF BREAST LESION IDENTIFIED BY PRE-OPERATIVE PLACEMENT OF RADIOLOGICAL $280.86 20060701 99999999 19126 EXCISION OF BREAST LESION IDENTIFIED BY PRE-OPERATIVE PLACEMENT OF RADIOLOGICAL $126.42 20060701 99999999 19140 MASTECTOMY FOR GYNECOMASTIA THROUGH CIRCUMAREOLAR OR OTHER INCISION $276.48 20030401 99999999 19160 MASTECTOMY, PARTIAL $310.90 19990701 99999999 19162 MASTECTOMY, PARTIAL $672.89 19990701 99999999 19180 MASTECTOMY, SIMPLE, COMPLETE $440.52 19990701 99999999 19182 MASTECTOMY, SUBCUTANEOUS $402.68 19990701 99999999 19200 MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, $760.17 19990701 99999999 19220 MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY $772.58 19990701 99999999 19240 MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES $759.76 19990701 99999999 19260 EXCISION OF CHEST WALL TUMOR INCLUDING RIBS $695.15 20060701 99999999 19271 EXCISION OF CHEST WALL TUMOR INVOLVING RIBS, WITH PLASTIC $1,001.14 20060701 99999999 19272 EXCISION OF CHEST WALL TUMOR INVOLVING RIBS, WITH PLASTIC $1,066.32 20060701 99999999 19290 PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST; $47.76 20060701 99999999 19291 PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST; EACH ADDITIONAL LESI $24.19 20060701 99999999 19295 IMAGE GUIDED PLACEMENT, METALLIC LOCALIZATION CLIP, PERCUTANEOUS, DURING BREAST $75.00 20060701 99999999 19296 PLACEMENT OF RADIOTHERAPY AFTERLOADING BALLOON CATHETER INTO THE BREAST FOR $128.15 20060701 99999999 19297 PLACEMENT OF RADIOTHERAPY AFTERLOADING BALLOON CATHETER INTO THE BREAST FOR $70.21 20060701 99999999 19298 PLACEMENT OF RADIOTHERAPY AFTERLOADING BRACHYTHERAPY CATHETERS (MULTIPLE TUBE $246.79 20060701 99999999 19300 MAMMOPLASTY,REDUC,REPOSITION,ONE STAGE,UNILTRL $242.52 20070101 99999999 19301 MAMMOPLASTY,RED,REPOSTON,1 STAGE;BILAT $263.45 20070101 99999999 19302 MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); $556.02 20070101 99999999 19303 MAMMOPLSTY; REDUCE,REPOSITION,TWO STAGE UNILATERAL $563.27 20070101 99999999 19304 MAMMOPLSTY,RED,REPOSITION; TWO STAGE; BILAT $350.60 20070101 99999999 19305 MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY LYMPH NODES $690.04 20070101 99999999 19306 MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY AND INTERNAL MAMMARY L $717.28 20070101 99999999 19307 MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PE $721.02 20070101 99999999 19316 MASTOPEXY $617.47 20060701 99999999 19318 REDUCTION MAMMAPLASTY $844.14 20060701 99999999 19324 MAMMAPLASTY, AUGMENTATION $279.65 20060701 99999999 19325 MAMMAPLASTY, AUGMENTATION $418.34 20060701 99999999 19328 REMOVAL OF INTACT MAMMARY IMPLANT $292.70 20060701 99999999 19330 REMOVAL OF MAMMARY IMPLANT MATERIAL $361.70 20060701 99999999 19340 IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, $351.48 20060701 99999999 19342 DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, $620.86 20060701 99999999 19350 NIPPLE/AREOLA RECONSTRUCTION $475.32 20060701 99999999 19355 CORRECTION OF INVERTED NIPPLES $371.15 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 103
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