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Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END<br />

24220 INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY $50.57 20060701 99999999<br />

24300 MANIPULATION, ELBOW, UNDER ANESTHESIA $268.70 20060701 99999999<br />

24301<br />

MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW,<br />

SINGLE $559.90 20060701 99999999<br />

24305 TENDON LENGTHENING, UPPER ARM OR ELBOW, SINGLE, EACH $369.55 20060701 99999999<br />

24310 TENOTOMY, OPEN, ELBOW TO SHOULDER, SINGLE, EACH $329.10 20060701 99999999<br />

24320 TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT $611.83 20060701 99999999<br />

24330 FLEXOR-PLASTY, ELBOW, (EG, STEINDLER TYPE ADVANCEMENT) $545.74 20060701 99999999<br />

24331 FLEXOR-PLASTY, ELBOW, (EG, STEINDLER TYPE ADVANCEMENT) $598.45 20060701 99999999<br />

24332 TENOLYSIS, TRICEPS $363.93 20060701 99999999<br />

24340 TENODESIS FOR RUPTURE OF BICEPS TENDON AT ELBOW $450.93 20060701 99999999<br />

24341<br />

REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON<br />

ORMUSCLE, PRIMARY OR $453.94 20060701 99999999<br />

24342 REINSERTION OF RUPTURED BICEPS TENDON, DISTAL, $614.56 20060701 99999999<br />

24343<br />

REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL<br />

TISSUE $482.80 20060701 99999999<br />

24344<br />

RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH<br />

TENDON GRAFT (INCLUDES H $724.62 20060701 99999999<br />

24345 REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE $482.80 20060701 99999999<br />

24346<br />

RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH<br />

TENDON GRAFT (INCLUDES HA $724.62 20060701 99999999<br />

24350 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $305.14 19990701 99999999<br />

24351 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $337.62 19990701 99999999<br />

24352 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $379.43 19990701 99999999<br />

24354 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $378.45 19990701 99999999<br />

24356 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $412.28 19990701 99999999<br />

24357<br />

TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS,<br />

TENNIS ELBOW, GOLFER'S EL $228.19 <strong>200801</strong>01 99999999<br />

24358<br />

TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS,<br />

TENNIS ELBOW, GOLFER'S EL $266.71 <strong>200801</strong>01 99999999<br />

24359<br />

TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS,<br />

TENNIS ELBOW, GOLFER'S EL $324.38 <strong>200801</strong>01 99999999<br />

24360 ARTHROPLASTY, ELBOW $729.27 20060701 99999999<br />

24361 ARTHROPLASTY, ELBOW $783.88 20060701 99999999<br />

24362 ARTHROPLASTY, ELBOW $817.90 20060701 99999999<br />

24363 ARTHROPLASTY, ELBOW $1,077.13 20060701 99999999<br />

24365 ARTHROPLASTY, RADIAL HEAD $483.37 20060701 99999999<br />

24366 ARTHROPLASTY, RADIAL HEAD $552.25 20060701 99999999<br />

24400 OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION $641.55 20060701 99999999<br />

24410 MULTIPLE OSTEOTOMIES WITH REALIGNMENT ON $854.41 20060701 99999999<br />

24420<br />

OSTEOPLASTY, HUMERUS (EG, SHORTENING OR LENGTHENING)<br />

(EXCLUDING 64876) $822.54 20060701 99999999<br />

24430 REPAIR OF NONUNION OR MALUNION, HUMERUS $786.24 20060701 99999999<br />

24435 REPAIR OF NONUNION OR MALUNION, HUMERUS $820.73 20060701 99999999<br />

24470 HEMIEPIPHYSEAL ARREST (EG, FOR CUBITUS VARUS $500.70 20060701 99999999<br />

24495 DECOMPRESSION FASCIOTOMY, FOREARM, WITH BRACHIAL $481.02 20060701 99999999<br />

24498 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) $696.94 20060701 99999999<br />

24500 TREATMENT OF CLOSED HUMERAL SHAFT FRACTURE $182.00 20060701 99999999<br />

24505 TREATMENT OF CLOSED HUMERAL SHAFT FRACTURE $319.62 20060701 99999999<br />

24515 OPEN TREATMENT OF CLOSED OR OPEN HUMERAL SHAFT $657.83 20060701 99999999<br />

24516<br />

OPEN TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION<br />

OF INTRAMEDULLARY IMPLA $665.38 20060701 99999999<br />

24530<br />

TREATMENT OF CLOSED HUMERAL SUPRACONDYLAR OR<br />

TRANSCONDYLAR $213.78 20060701 99999999<br />

24535<br />

TREATMENT OF CLOSED HUMERAL SUPRACONDYLAR OR<br />

TRANSCONDYLAR $375.67 20060701 99999999<br />

Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 116

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