Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 24220 INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY $50.57 20060701 99999999 24300 MANIPULATION, ELBOW, UNDER ANESTHESIA $268.70 20060701 99999999 24301 MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW, SINGLE $559.90 20060701 99999999 24305 TENDON LENGTHENING, UPPER ARM OR ELBOW, SINGLE, EACH $369.55 20060701 99999999 24310 TENOTOMY, OPEN, ELBOW TO SHOULDER, SINGLE, EACH $329.10 20060701 99999999 24320 TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT $611.83 20060701 99999999 24330 FLEXOR-PLASTY, ELBOW, (EG, STEINDLER TYPE ADVANCEMENT) $545.74 20060701 99999999 24331 FLEXOR-PLASTY, ELBOW, (EG, STEINDLER TYPE ADVANCEMENT) $598.45 20060701 99999999 24332 TENOLYSIS, TRICEPS $363.93 20060701 99999999 24340 TENODESIS FOR RUPTURE OF BICEPS TENDON AT ELBOW $450.93 20060701 99999999 24341 REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON ORMUSCLE, PRIMARY OR $453.94 20060701 99999999 24342 REINSERTION OF RUPTURED BICEPS TENDON, DISTAL, $614.56 20060701 99999999 24343 REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE $482.80 20060701 99999999 24344 RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES H $724.62 20060701 99999999 24345 REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE $482.80 20060701 99999999 24346 RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HA $724.62 20060701 99999999 24350 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $305.14 19990701 99999999 24351 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $337.62 19990701 99999999 24352 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $379.43 19990701 99999999 24354 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $378.45 19990701 99999999 24356 FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' $412.28 19990701 99999999 24357 TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL $228.19 20080101 99999999 24358 TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL $266.71 20080101 99999999 24359 TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL $324.38 20080101 99999999 24360 ARTHROPLASTY, ELBOW $729.27 20060701 99999999 24361 ARTHROPLASTY, ELBOW $783.88 20060701 99999999 24362 ARTHROPLASTY, ELBOW $817.90 20060701 99999999 24363 ARTHROPLASTY, ELBOW $1,077.13 20060701 99999999 24365 ARTHROPLASTY, RADIAL HEAD $483.37 20060701 99999999 24366 ARTHROPLASTY, RADIAL HEAD $552.25 20060701 99999999 24400 OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION $641.55 20060701 99999999 24410 MULTIPLE OSTEOTOMIES WITH REALIGNMENT ON $854.41 20060701 99999999 24420 OSTEOPLASTY, HUMERUS (EG, SHORTENING OR LENGTHENING) (EXCLUDING 64876) $822.54 20060701 99999999 24430 REPAIR OF NONUNION OR MALUNION, HUMERUS $786.24 20060701 99999999 24435 REPAIR OF NONUNION OR MALUNION, HUMERUS $820.73 20060701 99999999 24470 HEMIEPIPHYSEAL ARREST (EG, FOR CUBITUS VARUS $500.70 20060701 99999999 24495 DECOMPRESSION FASCIOTOMY, FOREARM, WITH BRACHIAL $481.02 20060701 99999999 24498 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) $696.94 20060701 99999999 24500 TREATMENT OF CLOSED HUMERAL SHAFT FRACTURE $182.00 20060701 99999999 24505 TREATMENT OF CLOSED HUMERAL SHAFT FRACTURE $319.62 20060701 99999999 24515 OPEN TREATMENT OF CLOSED OR OPEN HUMERAL SHAFT $657.83 20060701 99999999 24516 OPEN TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLA $665.38 20060701 99999999 24530 TREATMENT OF CLOSED HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR $213.78 20060701 99999999 24535 TREATMENT OF CLOSED HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR $375.67 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 116
PROC-CODE DESC MAC BEG END 24538 TREATMENT OF CLOSED HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR $550.73 20060701 99999999 24545 OPEN TREATMENT OF CLOSED OR OPEN HUMERAL SUPRACONDYLAR OR $612.66 20060701 99999999 24546 OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, WITH OR WITHO $815.91 20060701 99999999 24560 TREATMENT OF CLOSED HUMERAL EPICONDYLAR FRACTURE, MEDIAL $160.55 20060701 99999999 24565 TREATMENT OF CLOSED HUMERAL EPICONDYLAR FRACTURE, MEDIAL $300.33 20060701 99999999 24566 PERCUTANEOUS SKELETAL FIXATION OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERA $456.90 20060701 99999999 24575 OPEN TREATMENT OF CLOSED OR OPEN HUMERAL EPICONDYLAR $559.48 20060701 99999999 24576 TREATMENT OF CLOSED HUMERAL CONDYLAR FRACTURE, MEDIAL $167.70 20060701 99999999 24577 TREATMENT OF CLOSED HUMERAL CONDYLAR FRACTURE, MEDIAL $320.54 20060701 99999999 24579 OPEN TREATMENT OF CLOSED OR OPEN HUMERAL CONDYLAR FRACTURE, $619.22 20060701 99999999 24582 PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, $500.93 20060701 99999999 24586 OPEN TREATMENT OF CLOSED OR OPEN COMMINUTED ELBOW $847.62 20060701 99999999 24587 OPEN TREATMENT OF CLOSED OR OPEN COMMINUTED ELBOW $823.20 20060701 99999999 24600 TREATMENT OF CLOSED ELBOW DISLOCATION $225.39 20060701 99999999 24605 TREATMENT OF CLOSED ELBOW DISLOCATION $275.73 20060701 99999999 24615 OPEN TREATMENT OF CLOSED OR OPEN ELBOW DISLOCATION $540.99 20060701 99999999 24620 TREATMENT OF CLOSED MONTEGGIA TYPE OF FRACTURE $358.42 20060701 99999999 24635 OPEN TREATMENT OF CLOSED OR OPEN MONTEGGIA TYPE $869.22 20060701 99999999 24640 TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, $76.75 20060701 99999999 24650 TREATMENT OF CLOSED RADIAL HEAD OR NECK FRACTURE $125.45 20060701 99999999 24655 TREATMENT OF CLOSED RADIAL HEAD OR NECK FRACTURE $250.88 20060701 99999999 24665 OPEN TREATMENT OF CLOSED OR OPEN RADIAL HEAD OR $486.33 20060701 99999999 24666 OPEN TREATMENT OF CLOSED OR OPEN RADIAL HEAD OR $588.99 20060701 99999999 24670 TREATMENT OF CLOSED ULNAR FRACTURE, PROXIMAL $149.15 20060701 99999999 24675 TREATMENT OF CLOSED ULNAR FRACTURE, PROXIMAL $272.48 20060701 99999999 24685 OPEN TREATMENT OF CLOSED OR OPEN ULNAR FRACTURE $532.27 20060701 99999999 24800 ARTHRODESIS, ELBOW JOINT $635.88 20060701 99999999 24802 ARTHRODESIS, ELBOW JOINT $762.00 20060701 99999999 24900 AMPUTATION, ARM THROUGH HUMERUS $555.59 20060701 99999999 24920 AMPUTATION, ARM THROUGH HUMERUS $550.56 20060701 99999999 24925 AMPUTATION, ARM THROUGH HUMERUS $429.96 20060701 99999999 24930 AMPUTATION, ARM THROUGH HUMERUS $601.44 20060701 99999999 24931 AMPUTATION, ARM THROUGH HUMERUS $683.32 20060701 99999999 24935 STUMP ELONGATION, UPPER EXTREMITY $855.46 20060701 99999999 25000 TENDON SHEATH INCISION $261.08 20060701 99999999 25001 INCISION, FLEXOR TENDON SHEATH, WRIST (EG, FLEXOR CARPI RADIALIS) $223.58 20060701 99999999 25020 DECOMPRESSION FASCIOTOMY, WRIST, FLEXOR AND/OR EXTENSOR COMPARTMENT $394.24 20060701 99999999 25023 DECOMPRESSION FASCIOTOMY, WRIST, FLEXOR AND/OR EXTENSOR COMPARTMENT $711.07 20060701 99999999 25024 DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR COMPARTMENT; $512.29 20060701 99999999 25025 DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR COMPARTMENT; $824.32 20060701 99999999 25028 INCISION AND DRAINAGE, FOREARM AND/OR WRIST $341.13 20060701 99999999 25031 INCISION AND DRAINAGE, FOREARM AND/OR WRIST $306.43 20060701 99999999 25035 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR $534.85 20060701 99999999 25040 ARTHROTOMY, RADIOCARPAL OR MEDIOCARPAL JOINT, FOR INFECTION, $424.25 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 117
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