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Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END<br />

26357<br />

FLEXOR TENDON REPAIR OR ADVANCE SINGLE SECONDARY EACH<br />

TENDON $616.15 20060701 99999999<br />

26358 FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, IN $655.37 20060701 99999999<br />

26370 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT $565.35 20060701 99999999<br />

26372 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT $644.27 20060701 99999999<br />

26373 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT $615.10 20060701 99999999<br />

26390 FLEXOR TENDON EXCISION, IMPLANTATION OF PLASTIC TUBE $605.92 20060701 99999999<br />

26392 REMOVAL OF TUBE OR ROD AND INSERTION OF FLEXOR TENDON $756.22 20060701 99999999<br />

26410 EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, $421.25 20060701 99999999<br />

26412 EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, $497.86 20060701 99999999<br />

26415<br />

EXTENSOR TENDON EXCISION OMPLANTATION OF PLASTIC TUBE OR<br />

ROD $554.26 20060701 99999999<br />

26416<br />

REMOVAL TUBE OR ROD AND INSERT OF EXTENSOR TENDON GRAFT<br />

HAND $764.02 20060701 99999999<br />

26418 EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, $421.33 20060701 99999999<br />

26420 EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, $536.27 20060701 99999999<br />

26426 EXTENSOR TENDON REPAIR, CENTRAL SLIP REPAIR, $491.06 20060701 99999999<br />

26428 EXTENSOR TENDON REPAIR, CENTRAL SLIP REPAIR, $535.51 20060701 99999999<br />

26432 EXTENSOR TENDON REPAIR, DISTAL INSERTION (''MALLET FINGER''), $363.23 20060701 99999999<br />

26433 EXTENSOR TENDON REPAIR, DISTAL INSERTION ('MALLET FINGER'), $390.41 20060701 99999999<br />

26434 EXTENSOR TENDON REPAIR, DISTAL INSERTION ('MALLET FINGER'), $448.15 20060701 99999999<br />

26437 EXTENSOR TENDON REALIGNMENT, HAND $442.01 20060701 99999999<br />

26440 TENOLYSIS, SIMPLE, FLEXOR TENDON $468.42 20060701 99999999<br />

26442 TENOLYSIS, SIMPLE, FLEXOR TENDON $612.02 20060701 99999999<br />

26445 TENOLYSIS, EXTENSOR TENDON, DORSUM OF HAND OR FINGER $443.05 20060701 99999999<br />

26449 TENOLYSIS, COMPLEX, EXTENSOR TENDON, DORSUM OF HAND OR $578.67 20060701 99999999<br />

26450 TENOTOMY, FLEXOR, SINGLE, PALM, OPEN, EACH $280.05 20060701 99999999<br />

26455 TENOTOMY, FLEXOR, SINGLE, FINGER, OPEN, EACH $277.92 20060701 99999999<br />

26460 TENOTOMY, EXTENSOR, HAND OR FINGER, SINGLE, OPEN, EACH $269.72 20060701 99999999<br />

26471 TENODESIS $431.43 20060701 99999999<br />

26474 TENODESIS $423.67 20060701 99999999<br />

26476 TENDON LENGTHENING, EXTENSOR, HAND OR FINGER, SINGLE, EACH $409.39 20060701 99999999<br />

26477 TENDON SHORTENING, EXTENSOR, HAND OR FINGER, SINGLE, EACH $412.36 20060701 99999999<br />

26478 TENDON LENGTHENING FLEXOR HAND OR FINGER SINGLE EACH $448.55 20060701 99999999<br />

26479 TENDON SHORTENING FLEXOR HAND OR FINGER SINGLE EACH $440.47 20060701 99999999<br />

26480 TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL $552.17 20060701 99999999<br />

26483 TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL $653.26 20060701 99999999<br />

26485 TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, $589.51 20060701 99999999<br />

26489 TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, $546.35 20060701 99999999<br />

26490 OPPONENS PLASTY $568.97 20060701 99999999<br />

26492 OPPONENS PLASTY $635.31 20060701 99999999<br />

26494 OPPONENS PLASTY $623.45 20060701 99999999<br />

26496 OPPONENS PLASTY $619.88 20060701 99999999<br />

26497 TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION $617.72 20060701 99999999<br />

26498 TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION $856.37 20060701 99999999<br />

26499 CORRECTION CLAW FINGER, OTHER METHODS $613.40 20060701 99999999<br />

26500 TENDON PULLEY RECONSTRUCTION $442.10 20060701 99999999<br />

26502 TENDON PULLEY RECONSTRUCTION $487.90 20060701 99999999<br />

26504<br />

TENDON PULLEY RECONSTRUCTION W/TENDON PROSTHESIS (SEP<br />

PROC) $498.62 19990701 99999999<br />

26508 THENAR MUSCLE RELEASE FOR THUMB CONTRACTURE $450.76 20060701 99999999<br />

26510 CROSS INTRINSIC TRANSFER $425.47 20060701 99999999<br />

26516 CAPSULODESIS FOR M-P JOINT STABILIZATION $493.15 20060701 99999999<br />

26517 CAPSULODESIS FOR M-P JOINT STABILIZATION $582.40 20060701 99999999<br />

26518 CAPSULODESIS FOR M-P JOINT STABILIZATION $571.87 20060701 99999999<br />

26520 CAPSULECTOMY OR CAPSULOTOMY FOR CONTRACTURE $487.34 20060701 99999999<br />

26525 CAPSULECTOMY OR CAPSULOTOMY FOR CONTRACTURE $490.24 20060701 99999999<br />

Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 122

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