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 />
23620 TREATMENT OF CLOSED GREATER TUBEROSITY FRACTURE $138.66 20060701 99999999<br />
23625 TREATMENT OF CLOSED GREATER TUBEROSITY FRACTURE $253.74 20060701 99999999<br />
23630 OPEN TREATMENT OF CLOSED OR OPEN GREATER TUBEROSITY $464.22 20060701 99999999<br />
23650 TREATMENT OF CLOSED SHOULDER DISLOCATION, WITH $180.50 20060701 99999999<br />
23655 TREATMENT OF CLOSED SHOULDER DISLOCATION, WITH $239.70 20060701 99999999<br />
23660 OPEN TREATMENT OF CLOSED OR OPEN SHOULDER DISLOCATION $464.21 20060701 99999999<br />
23665 TREATMENT OF CLOSED SHOULDER DISLOCATION, WITH $265.46 20060701 99999999<br />
23670 OPEN TREATMENT OF CLOSED OR OPEN SHOULDER DISLOCATION, $494.23 20060701 99999999<br />
23675 TREATMENT OF CLOSED SHOULDER DISLOCATION, WITH SURGICAL $333.81 20060701 99999999<br />
23680 OPEN TREATMENT OF CLOSED OR OPEN SHOULDER DISLOCATION, $614.28 20060701 99999999<br />
23700 MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING $153.92 20060701 99999999<br />
23800 ARTHRODESIS, SHOULDER JOINT $876.10 20060701 99999999<br />
23802 ARTHRODESIS, SHOULDER JOINT $878.67 20060701 99999999<br />
23900 INTERTHORACOSCAPULAR AMPUTATION (FOREQUARTER) $998.77 20060701 99999999<br />
23920 DISARTICULATION OF SHOULDER $841.12 20060701 99999999<br />
23921 DISARTICULATION OF SHOULDER $322.61 20060701 99999999<br />
23929 UNLISTED PROCEDURE, SHOULDER $313.82 19990701 99999999<br />
23930 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA $166.04 20060701 99999999<br />
23931 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA $104.39 20060701 99999999<br />
23935 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR $416.26 20060701 99999999<br />
24000<br />
ARTHROTOMY, ELBOW, FOR INFECTION, WITH EXPLORATION,<br />
DRAINAGE OR $357.63 20060701 99999999<br />
24006<br />
ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR<br />
CAPSULAR RELEASE (SEPARATE P $511.08 20060701 99999999<br />
24065 BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA $107.39 20060701 99999999<br />
24066 BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA $286.56 20060701 99999999<br />
24075 EXCISION, TUMOR, UPPER ARM OR ELBOW AREA $225.58 20060701 99999999<br />
24076 EXCISION, TUMOR, UPPER ARM OR ELBOW AREA $340.26 20060701 99999999<br />
24077<br />
RAD RESECT OF TUMOR SOFT TISSUE OF UPPER ARM OR ELBOW<br />
AREA $685.30 20060701 99999999<br />
24100 ARTHROTOMY, ELBOW $304.37 20060701 99999999<br />
24101 ARTHROTOMY, ELBOW $385.44 20060701 99999999<br />
24102 ARTHROTOMY, ELBOW $490.98 20060701 99999999<br />
24105 EXCISION, OLECRANON BURSA $235.26 20060701 99999999<br />
24110 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $472.26 20060701 99999999<br />
24115 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $584.41 20060701 99999999<br />
24116 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $670.21 20060701 99999999<br />
24120 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $385.10 20060701 99999999<br />
24125 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $426.91 20060701 99999999<br />
24126 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $472.54 20060701 99999999<br />
24130 EXCISION, RADIAL HEAD $387.54 20060701 99999999<br />
24134 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), $631.40 20060701 99999999<br />
24136 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), $466.41 20060701 99999999<br />
24138 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), $449.34 20060701 99999999<br />
24140 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION OR $631.84 20060701 99999999<br />
24145 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION OR $476.07 20060701 99999999<br />
24147 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION OR $474.53 20060701 99999999<br />
24149<br />
RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPIC<br />
BONE, ELBOW, WITH CON $789.53 20060701 99999999<br />
24150 RADICAL RESECTION FOR TUMOR, SHAFT OR DISTAL HUMERUS $823.48 20060701 99999999<br />
24151 RADICAL RESECTION FOR TUMOR, SHAFT OR DISTAL HUMERUS $895.14 20060701 99999999<br />
24152 RADICAL RESECTION FOR TUMOR, RADIAL HEAD OR NECK $532.44 20060701 99999999<br />
24153 RADICAL RESECTION FOR TUMOR, RADIAL HEAD OR NECK $603.00 20060701 99999999<br />
24155 RESECTION OF ELBOW JOINT (ARTHRECTOMY) $657.94 20060701 99999999<br />
24160 IMPLANT REMOVAL $413.36 20060701 99999999<br />
24164 IMPLANT REMOVAL $365.18 20060701 99999999<br />
24200 REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA $96.60 20060701 99999999<br />
24201 REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA $273.94 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 115