Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
PROC-CODE DESC MAC BEG END<br />
21435 OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE) $751.37 20060701 99999999<br />
21436<br />
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE);<br />
COMPLICATED, MULTIP $1,157.62 20060701 99999999<br />
21440<br />
MANIPULATIVE TREATMENT OF ALVEOLAR RIDGE FRACTURE<br />
(SEPARATE PROCEDURE) $224.74 20060701 99999999<br />
21445<br />
OPEN TREATMENT OF ALVEOLAR RIDGE FRACTURE (SEPARATE<br />
PROCEDURE) $348.86 20060701 99999999<br />
21450 TREATMENT OF CLOSED OR OPEN MANDIBULAR FRACTURE $247.93 20060701 99999999<br />
21451 TREATMENT OF CLOSED OR OPEN MANDIBULAR FRACTURE $335.23 20060701 99999999<br />
21452 TREATMENT OF OPEN MANDIBULAR FRACTURE $166.87 20060701 99999999<br />
21453 TREATMENT OF OPEN MANDIBULAR FRACTURE $411.66 20060701 99999999<br />
21454<br />
OPEN TREATMENT OF CLOSED OR OPEN MANDIBULAR FRACTURE<br />
WITH $347.39 20060701 99999999<br />
21461 OPEN TREATMENT OF CLOSED OR OPEN MANDIBULAR FRACTURE $523.31 20060701 99999999<br />
21462 OPEN TREATMENT OF CLOSED OR OPEN MANDIBULAR FRACTURE $717.68 20060701 99999999<br />
21465 OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTURE $547.58 20060701 99999999<br />
21470 OPEN TREATMENT OF COMPLICATED CLOSED OR OPEN MANDIBULAR $1,014.18 20060701 99999999<br />
UNCOMPLICATED TREATMENT OF TEMPOROMANDIBULAR<br />
21480 DISLOCATION, $54.73 20060701 99999999<br />
21485 COMPLICATED MANIPULATIVE TREATMENT OF TEMPOROMANDIBULAR $294.25 20060701 99999999<br />
21490 OPEN TREATMENT OF TEMPOROMANDIBULAR DISLOCATION $551.78 20060701 99999999<br />
21494 TREATMENT OF CLOSED OR OPEN HYOID FRACTURE $296.09 19990701 99999999<br />
21495 OPEN TREATMENT OF CLOSED OR OPEN HYOID FRACTURE $351.38 20060701 99999999<br />
21497 INTERDENTAL WIRING, FOR CONDITION OTHER THAN FRACTURE $290.59 20060701 99999999<br />
21501<br />
INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT<br />
TISSUES $202.17 20060701 99999999<br />
21502<br />
INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT<br />
TISSUES $322.86 20060701 99999999<br />
21510 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR $288.98 20060701 99999999<br />
21550 BIOPSY, SOFT TISSUE OF NECK OR THORAX $106.18 20060701 99999999<br />
21555 EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX $190.68 20060701 99999999<br />
21556 EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX $275.32 20060701 99999999<br />
21557 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), $358.00 20060701 99999999<br />
21600 EXCISION OF RIB, PARTIAL $320.49 20060701 99999999<br />
21610 COSTOTRANSVERSECTOMY (SEPARATE PROCEDURE) $613.84 20060701 99999999<br />
21615 EXCISION FIRST AND/OR CERVICAL RIB FOR OUTLET $513.99 20060701 99999999<br />
21616 EXCISION FIRST AND/OR CERVICAL RIB FOR OUTLET $511.63 20060701 99999999<br />
21620 OSTECTOMY OF STERNUM, PARTIAL $324.09 20060701 99999999<br />
21627 STERNAL DEBRIDEMENT $523.07 20060701 99999999<br />
21630 RADICAL RESECTION OF STERNUM $743.29 20060701 99999999<br />
21632 RADICAL RESECTION OF STERNUM $743.48 20060701 99999999<br />
21685 HYOID MYOTOMY AND SUSPENSION $658.65 20060701 99999999<br />
21700 DIVISION OF SCALENUS ANTICUS $367.96 20060701 99999999<br />
21705 DIVISION OF SCALENUS ANTICUS $474.43 20060701 99999999<br />
21720 DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, $208.52 20060701 99999999<br />
21725 DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, $319.45 20060701 99999999<br />
21740 RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM $635.27 20060701 99999999<br />
21750<br />
CLOSURE OF STERNOTOMY SEPARATION WITH OR WITHOUT<br />
DEBRIDEMENT (SEPARATE PROCEDURE $654.42 20060701 99999999<br />
21800 TREATMENT OF RIB FRACTURE $57.43 20060701 99999999<br />
21805 TREATMENT OF RIB FRACTURE $150.85 20060701 99999999<br />
21810 TREATMENT OF RIB FRACTURE $299.44 20060701 99999999<br />
21820 TREATMENT OF STERNUM FRACTURE $76.88 20060701 99999999<br />
21825 TREATMENT OF STERNUM FRACTURE $351.23 20060701 99999999<br />
21899 UNLISTED PROCEDURE, NECK OR THORAX $307.00 19990701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 110