Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 26357 FLEXOR TENDON REPAIR OR ADVANCE SINGLE SECONDARY EACH TENDON $616.15 20060701 99999999 26358 FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, IN $655.37 20060701 99999999 26370 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT $565.35 20060701 99999999 26372 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT $644.27 20060701 99999999 26373 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT $615.10 20060701 99999999 26390 FLEXOR TENDON EXCISION, IMPLANTATION OF PLASTIC TUBE $605.92 20060701 99999999 26392 REMOVAL OF TUBE OR ROD AND INSERTION OF FLEXOR TENDON $756.22 20060701 99999999 26410 EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, $421.25 20060701 99999999 26412 EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, $497.86 20060701 99999999 26415 EXTENSOR TENDON EXCISION OMPLANTATION OF PLASTIC TUBE OR ROD $554.26 20060701 99999999 26416 REMOVAL TUBE OR ROD AND INSERT OF EXTENSOR TENDON GRAFT HAND $764.02 20060701 99999999 26418 EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, $421.33 20060701 99999999 26420 EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, $536.27 20060701 99999999 26426 EXTENSOR TENDON REPAIR, CENTRAL SLIP REPAIR, $491.06 20060701 99999999 26428 EXTENSOR TENDON REPAIR, CENTRAL SLIP REPAIR, $535.51 20060701 99999999 26432 EXTENSOR TENDON REPAIR, DISTAL INSERTION (''MALLET FINGER''), $363.23 20060701 99999999 26433 EXTENSOR TENDON REPAIR, DISTAL INSERTION ('MALLET FINGER'), $390.41 20060701 99999999 26434 EXTENSOR TENDON REPAIR, DISTAL INSERTION ('MALLET FINGER'), $448.15 20060701 99999999 26437 EXTENSOR TENDON REALIGNMENT, HAND $442.01 20060701 99999999 26440 TENOLYSIS, SIMPLE, FLEXOR TENDON $468.42 20060701 99999999 26442 TENOLYSIS, SIMPLE, FLEXOR TENDON $612.02 20060701 99999999 26445 TENOLYSIS, EXTENSOR TENDON, DORSUM OF HAND OR FINGER $443.05 20060701 99999999 26449 TENOLYSIS, COMPLEX, EXTENSOR TENDON, DORSUM OF HAND OR $578.67 20060701 99999999 26450 TENOTOMY, FLEXOR, SINGLE, PALM, OPEN, EACH $280.05 20060701 99999999 26455 TENOTOMY, FLEXOR, SINGLE, FINGER, OPEN, EACH $277.92 20060701 99999999 26460 TENOTOMY, EXTENSOR, HAND OR FINGER, SINGLE, OPEN, EACH $269.72 20060701 99999999 26471 TENODESIS $431.43 20060701 99999999 26474 TENODESIS $423.67 20060701 99999999 26476 TENDON LENGTHENING, EXTENSOR, HAND OR FINGER, SINGLE, EACH $409.39 20060701 99999999 26477 TENDON SHORTENING, EXTENSOR, HAND OR FINGER, SINGLE, EACH $412.36 20060701 99999999 26478 TENDON LENGTHENING FLEXOR HAND OR FINGER SINGLE EACH $448.55 20060701 99999999 26479 TENDON SHORTENING FLEXOR HAND OR FINGER SINGLE EACH $440.47 20060701 99999999 26480 TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL $552.17 20060701 99999999 26483 TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL $653.26 20060701 99999999 26485 TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, $589.51 20060701 99999999 26489 TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, $546.35 20060701 99999999 26490 OPPONENS PLASTY $568.97 20060701 99999999 26492 OPPONENS PLASTY $635.31 20060701 99999999 26494 OPPONENS PLASTY $623.45 20060701 99999999 26496 OPPONENS PLASTY $619.88 20060701 99999999 26497 TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION $617.72 20060701 99999999 26498 TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION $856.37 20060701 99999999 26499 CORRECTION CLAW FINGER, OTHER METHODS $613.40 20060701 99999999 26500 TENDON PULLEY RECONSTRUCTION $442.10 20060701 99999999 26502 TENDON PULLEY RECONSTRUCTION $487.90 20060701 99999999 26504 TENDON PULLEY RECONSTRUCTION W/TENDON PROSTHESIS (SEP PROC) $498.62 19990701 99999999 26508 THENAR MUSCLE RELEASE FOR THUMB CONTRACTURE $450.76 20060701 99999999 26510 CROSS INTRINSIC TRANSFER $425.47 20060701 99999999 26516 CAPSULODESIS FOR M-P JOINT STABILIZATION $493.15 20060701 99999999 26517 CAPSULODESIS FOR M-P JOINT STABILIZATION $582.40 20060701 99999999 26518 CAPSULODESIS FOR M-P JOINT STABILIZATION $571.87 20060701 99999999 26520 CAPSULECTOMY OR CAPSULOTOMY FOR CONTRACTURE $487.34 20060701 99999999 26525 CAPSULECTOMY OR CAPSULOTOMY FOR CONTRACTURE $490.24 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 122
PROC-CODE DESC MAC BEG END 26530 ARTHROPLASTY, METACARPOPHALANGEAL JOINT $521.48 20060701 99999999 26531 ARTHROPLASTY, METACARPOPHALANGEAL JOINT $590.49 20060701 99999999 26535 ARTHROPLASTY INTERPHALANGEAL JOINT $359.11 20060701 99999999 26536 ARTHROPLASTY INTERPHALANGEAL JOINT $510.83 20060701 99999999 26540 PRIMARY REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT $479.17 20060701 99999999 26541 PRIMARY REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT $609.11 20060701 99999999 26542 PRIMARY REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT $477.93 20060701 99999999 26545 RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGEAL JOINT, SINGLE, $484.45 20060701 99999999 26546 REPAIR NON-UNION, METACARPAL OR PHALANX, (INCLUDES OBTAININGBONE GRAFT WITH OR $610.51 20060701 99999999 26548 REPAIR&RECONSTR FINGER VOLAR PLATE INTERPHALANGEAL JOINT $530.74 20060701 99999999 26550 POLLICIZATION OF A DIGIT $1,202.06 20060701 99999999 26551 TOE-TO-HAND TRANSFER WITH MICROVASCULAR ANASTOMOSIS; GREAT TOE "WRAP AROUND" WIT $2,507.36 20060701 99999999 26553 TOE-TO-HAND TRANSFER WITH MICROVASCLULAR ANASTOMOSIS GREAT TOE WRAP-AROUND WITH $2,485.72 20060701 99999999 26554 TOE-TO-HAND TRANSFER WITH MICROVASCULAR ANASTOMOSIS: GREAT TOE "WRAP-AROUND" WIT $2,923.25 20060701 99999999 26555 POSITIONAL CHANGE OF OTHER FINGER $1,019.30 20060701 99999999 26556 FREE TOE JOINT TRANSFER WITH MICROVASCULAR ANASTOMOSIS $2,577.84 20060701 99999999 26560 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE $386.51 20060701 99999999 26561 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE $695.87 20060701 99999999 26562 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE $817.15 20060701 99999999 26565 OSTEOTOMY FOR CORRECTION OF DEFORMITY $480.59 20060701 99999999 26567 OSTEOTOMY FOR CORRECTION OF DEFORMITY $477.19 20060701 99999999 26568 OSTEOPLASTY FOR LENGTHENING OF METACARPAL OR PHALANX $661.27 20060701 99999999 26580 REPAIR CLEFT HAND $1,025.86 20060701 99999999 26585 REPAIR BIFID DIGIT $794.94 19990701 99999999 26587 RECONSTRUCTION OF SUPERNUMERARY DIGIT SOFT TISSUE AND BONE $581.87 20060701 99999999 26590 REPAIR MACRODACTYLIA $1,041.77 20060701 99999999 26591 REPAIR, INTRINSIC MUSCLES OF HAND (SPECIFY) $326.78 20060701 99999999 26593 RELEASE, INTRINSIC MUSCLES OF HAND (SPECIFY) $417.23 20060701 99999999 26596 EXCISION OF CONSTRICTING RING OF FINGER, $524.30 20060701 99999999 26597 RELEASE OF SCAR CONTRACTURE, FLEXOR OR EXTENSOR, WITH SKIN $632.30 19990701 99999999 26600 TREATMENT OF CLOSED METACARPAL FRACTURE, SINGLE $117.44 20060701 99999999 26605 TREATMENT OF CLOSED METACARPAL FRACTURE, SINGLE $166.50 20060701 99999999 26607 TREATMENT OF CLOSED METACARPAL FRACTURE, SINGLE $323.57 20060701 99999999 26608 PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE $322.88 20060701 99999999 26615 OPEN TREATMENT OF CLOSED OR OPEN METACARPAL $339.62 20060701 99999999 26641 TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, $199.66 20060701 99999999 26645 TREATMENT OF CLOSED CARPOMETACARPAL FRACTURE $235.74 20060701 99999999 26650 TREATMENT OF CLOSED CARPOMETACARPAL FRACTURE $346.20 20060701 99999999 26665 OPEN TREATMENT OF CLOSED OR OPEN CARPOMETACARPAL $449.09 20060701 99999999 26670 TREATMENT OF CLOSED CARPOMETACARPAL DISLOCATION, $187.91 20060701 99999999 26675 TREATMENT OF CLOSED CARPOMETACARPAL DISLOCATION, $266.13 20060701 99999999 26676 TREATMENT OF CLOSED CARPOMETACARPAL DISLOCATION, $359.15 20060701 99999999 26685 OPEN TREATMENT OF CLOSED OR OPEN CARPOMETACARPAL $414.75 20060701 99999999 26686 OPEN TREATMENT OF CLOSED OR OPEN CARPOMETACARPAL $459.42 20060701 99999999 26700 TREATMENT OF CLOSED METACARPOPHALANGEAL DISLOCATION, $162.97 20060701 99999999 26705 TREATMENT OF CLOSED METACARPOPHALANGEAL DISLOCATION, $216.41 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 123
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