Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
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PROC-CODE DESC MAC BEG END<br />
20612<br />
ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY<br />
LOCATION $28.14 20060701 99999999<br />
20615 ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST $130.44 20060701 99999999<br />
20650<br />
INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL<br />
TRACTION, $138.73 20060701 99999999<br />
20660<br />
APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC<br />
FRAME, $158.66 20060701 99999999<br />
20661 APPLICATION OF HALO, INCLUDING REMOVAL $308.58 20060701 99999999<br />
20662 APPLICATION OF HALO, INCLUDING REMOVAL $288.62 20060701 99999999<br />
20663 APPLICATION OF HALO, INCLUDING REMOVAL $263.23 20060701 99999999<br />
20664<br />
APPLICATION OF HALO, INCLUDING REMOVAL, CRANIAL, 6 OR MORE<br />
PINS PLACED, FOR THIN $432.00 20060701 99999999<br />
20665 REMOVAL OF TONGS OR HALO APPLIED BY ANOTHER PHYSICIAN $79.91 20060701 99999999<br />
20670 REMOVAL OF IMPLANT $137.06 20060701 99999999<br />
20680 REMOVAL OF IMPLANT $217.12 20060701 99999999<br />
20690 APPLICATION OF EXTERNAL FIXATION SYSTEM (EG, $192.28 20060701 99999999<br />
20692 APPLICATION OF A MULTIPLANE(PINS OR WIRES IN MORE THAN 1 PLA $330.69 20060701 99999999<br />
20693<br />
ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYS. REQ.<br />
ANESTH $368.18 20060701 99999999<br />
20694 DELETE $275.57 20060701 99999999<br />
20802<br />
REPLANTATION, ARM (INCLUDES SURGICAL NECK OF HUMERUS<br />
THROUGH $2,043.68 20060701 99999999<br />
20805 REPLANTATION, FOREARM (INCLUDES RADIUS AND ULNA TO RADIAL $2,519.44 20060701 99999999<br />
20808<br />
REPLANTATION, HAND (INCLUDES HAND THROUGH<br />
METACARPOPHALANGEAL JOINTS) $2,601.18 20060701 99999999<br />
20816 REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES $1,745.57 20060701 99999999<br />
20822 REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES DISTAL TIP TO $1,638.74 20060701 99999999<br />
20824 REPLANTATION, THUMB (INCLUDES CARPOMETACARPAL JOINT TO $1,715.63 20060701 99999999<br />
20827 REPLANTATION, THUMB (INCLUDES DISTAL TIP TO MP JOINT) $1,593.29 20060701 99999999<br />
20838 REPLANTATION, FOOT $1,959.62 20060701 99999999<br />
20900 BONE GRAFT, ANY DONOR AREA $288.13 20060701 99999999<br />
20902 BONE GRAFT, ANY DONOR AREA $424.70 20060701 99999999<br />
20910 CARTILAGE GRAFT $424.70 20060701 99999999<br />
20912 CARTILAGE GRAFT $304.21 20060701 99999999<br />
20920 FASCIA LATA GRAFT $239.98 20060701 99999999<br />
20922 FASCIA LATA GRAFT $286.84 20060701 99999999<br />
20924 TENDON GRAFT, FROM A DISTANCE (EG, PALMARIS, TOE EXTENSOR, $315.82 20060701 99999999<br />
20926 TISSUE GRAFTS, OTHER (EG, PARATENON, FAT, DERMIS, ETC) $293.90 20060701 99999999<br />
20930 ALLOGRAFT FOR SPINE SURGERY ONLY; MORSELIZED $138.47 19990701 99999999<br />
20931 ALLOGRAFT FOR SPINE SURGERY ONLY; STRUCTURAL $99.70 20060701 99999999<br />
20936<br />
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE<br />
GRAFT); LOCAL (EG, RIB $138.47 19990701 99999999<br />
20937<br />
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE<br />
GRAFT); MORSELIZED (TH $150.25 20060701 99999999<br />
20938<br />
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE<br />
GRAFT); STRUCTURAL, BI $164.43 20060701 99999999<br />
20950 MONITORING OF INTERSTITIAL FLUID PRESSURE (EG, WICK $80.39 20060701 99999999<br />
20955 BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS $2,007.53 20060701 99999999<br />
20956<br />
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS FIBULA ILIAC<br />
CREST $1,650.31 20060701 99999999<br />
20957<br />
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS FIBULA<br />
METATARSAL $1,817.07 20060701 99999999<br />
20962 BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS $1,687.16 20060701 99999999<br />
20969<br />
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR<br />
ANASTOMOSIS $2,211.44 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 105