Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 26706 TREATMENT OF CLOSED METACARPOPHALANGEAL DISLOCATION, $304.59 20060701 99999999 26715 OPEN TREATMENT OF CLOSED OR OPEN METACARPOPHALANGEAL $341.06 20060701 99999999 26720 TREATMENT OF CLOSED PHALANGEAL SHAFT FRACTURE, $94.34 20060701 99999999 26725 TREATMENT OF CLOSED PHALANGEAL SHAFT FRACTURE, $174.41 20060701 99999999 26727 TREATMENT OF UNSTABLE PHALANGEAL SHAFT FRACTURE, $303.06 20060701 99999999 26735 OPEN TREATMENT OF CLOSED OR OPEN PHALANGEAL SHAFT FRACTURE, $344.51 20060701 99999999 26740 TREATMENT OF CLOSED ARTICULAR FRACTURE, INVOLVING $118.43 20060701 99999999 26742 TREATMENT OF CLOSED ARTICULAR FRACTURE, INVOLVING $214.01 20060701 99999999 26746 OPEN TREATMENT OF CLOSED OR OPEN ARTICULAR FRACTURE, $356.56 20060701 99999999 26750 TREATMENT OF CLOSED DISTAL PHALANGEAL FRACTURE, $94.28 20060701 99999999 26755 TREATMENT OF CLOSED DISTAL PHALANGEAL FRACTURE, $154.52 20060701 99999999 26756 TREATMENT OF CLOSED DISTAL PHALANGEAL FRACTURE, $263.35 20060701 99999999 26765 OPEN TREATMENT OF CLOSED OR OPEN DISTAL PHALANGEAL $259.30 20060701 99999999 26770 TREATMENT OF CLOSED INTERPHALANGEAL JOINT $136.33 20060701 99999999 26775 TREATMENT OF CLOSED INTERPHALANGEAL JOINT $190.88 20060701 99999999 26776 TREATMENT OF CLOSED INTERPHALANGEAL JOINT $281.32 20060701 99999999 26785 OPEN TREATMENT OF CLOSED OR OPEN INTERPHALANGEAL $266.22 20060701 99999999 26820 FUSION IN OPPOSITION, THUMB, WITH AUTOGENOUS $560.16 20060701 99999999 26841 ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH $519.41 20060701 99999999 26842 ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH $593.06 20060701 99999999 26843 ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, $525.26 20060701 99999999 26844 ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, $572.40 20060701 99999999 26850 ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR $487.55 20060701 99999999 26852 ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR $541.94 20060701 99999999 26860 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR $403.67 20060701 99999999 26861 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR $97.39 20060701 99999999 26862 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR $500.95 20060701 99999999 26863 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR $203.10 20060701 99999999 26910 AMPUTATION, METACARPAL, WITH FINGER OR THUMB $487.40 20060701 99999999 26951 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, $374.75 20060701 99999999 26952 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, $456.57 20060701 99999999 26990 INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA $470.25 20060701 99999999 26991 INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA $345.22 20060701 99999999 26992 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR $740.38 20060701 99999999 27000 TENOTOMY, ADDUCTOR OF HIP, SUBCUTANEOUS, CLOSED $293.74 20060701 99999999 27001 TENOTOMY, ADDUCTOR OF HIP, SUBCUTANEOUS, OPEN $352.01 20060701 99999999 27003 TENOTOMY, ADDUCTOR, SUBCUTANEOUS, OPEN, $454.23 20060701 99999999 27005 TENOTOMY, ILIOPSOAS, OPEN (SEPARATE PROCEDURE) $476.20 20060701 99999999 27006 TENOTOMY, ABDUCTORS OF HIP, OPEN (SEPARATE PROCEDURE) $505.24 20060701 99999999 27025 OBER-YOUNT FASCIOTOMY, COMBINED WITH SPICA CAST, $573.77 20060701 99999999 27030 ARTHROTOMY, HIP, FOR INFECTION, WITH DRAINAGE $742.10 20060701 99999999 27033 ARTHROTOMY, HIP, FOR EXPLORATION OR REMOVAL OF $758.16 20060701 99999999 27035 HIP JOINT DENERVATION, INTRAPELVIC OR EXTRAPELVIC $910.10 20060701 99999999 27036 CAPSULECTOMY OR CAPSULOTOMY OF HIP, WITH OR WITHOUT EXCISIONOF HETEROTOPIC BONE $762.45 20060701 99999999 27040 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA $142.78 20060701 99999999 27041 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA $442.25 20060701 99999999 27047 EXCISION, TUMOR, PELVIS AND HIP AREA $346.22 20060701 99999999 27048 EXCISION, TUMOR, PELVIS AND HIP AREA $363.96 20060701 99999999 27049 RAD RESECT OF TUMOR SOFT TISSUE OF PELVIS AND HIP AREA $748.98 20060701 99999999 27050 ARTHROTOMY, FOR BIOPSY $294.49 20060701 99999999 27052 ARTHROTOMY, FOR BIOPSY $407.97 20060701 99999999 27054 ARTHROTOMY FOR SYNOVECTOMY, HIP JOINT $550.94 20060701 99999999 27060 EXCISION $317.92 20060701 99999999 27062 EXCISION $323.83 20060701 99999999 27065 EXCISION OF BONE CYST OR BENIGN TUMOR $381.13 20060701 99999999 27066 EXCISION OF BONE CYST OR BENIGN TUMOR $603.55 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 124
PROC-CODE DESC MAC BEG END 27067 EXCISION OF BONE CYST OR BENIGN TUMOR $798.75 20060701 99999999 27070 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION) $678.32 20060701 99999999 27071 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION) $725.12 20060701 99999999 27075 RADICAL RESECTION FOR TUMOR OR INFECTION $1,387.84 20060701 99999999 27076 RADICAL RESECTION FOR TUMOR OR INFECTION $1,196.52 20060701 99999999 27077 RADICAL RESECTION FOR TUMOR OR INFECTION $1,598.26 20060701 99999999 27078 RADICAL RESECTION FOR TUMOR OR INFECTION $750.93 20060701 99999999 27079 RADICAL RESECTION FOR TUMOR OR INFECTION $753.72 20060701 99999999 27080 COCCYGECTOMY, PRIMARY $367.40 20060701 99999999 27086 REMOVAL OF FOREIGN BODY, PELVIS OR HIP $108.17 20060701 99999999 27087 REMOVAL OF FOREIGN BODY, PELVIS OR HIP $430.06 20060701 99999999 27090 REMOVAL OF HIP PROSTHESIS $633.82 20060701 99999999 27091 REMOVAL OF HIP PROSTHESIS $1,224.30 20060701 99999999 27093 INJECTION PROCEDURE FOR HIP ARTHROGRAPHY $57.11 20060701 99999999 27095 INJECTION PROCEDURE FOR HIP ARTHROGRAPHY $65.12 20060701 99999999 27096 INJECTION PROCEDURE FOR SACROILIAC JOINT, ARTHROGRAPHY AND/OR ANESTHETIC/STEROID $42.43 20060701 99999999 27097 HAMSTRING RECESSION, PROXIMAL $515.06 20060701 99999999 27098 ADDUCTOR TRANSFER TO ISCHIUM $517.41 20060701 99999999 27100 TRANSFER EXTERNAL OBLIQUE MUSCLE TO GREATER $639.14 20060701 99999999 27105 TRANSFER PARASPINAL MUSCLE TO HIP (INCLUDES $605.99 20060701 99999999 27110 TRANSFER ILIOPSOAS $760.26 20060701 99999999 27111 TRANSFER ILIOPSOAS $712.11 20060701 99999999 27120 ACETABULOPLASTY $1,037.48 20060701 99999999 27122 ACETABULOPLASTY $914.04 20060701 99999999 27125 HEMIARTHROPLASTY OF HIP (PARTIAL HIP REPLACEMENT) $891.37 20060701 99999999 27130 ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL $1,385.91 20060701 99999999 27132 CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP REPLACEMENT $1,380.47 20060701 99999999 27134 REVISION OF TOTAL HIP ARTHROPLASTY $1,668.92 20060701 99999999 27137 REVISION OF TOTAL HIP ARTHROPLASTY $1,262.71 20060701 99999999 27138 REVISION OF TOTAL HIP ARTHROPLASTY $1,313.61 20060701 99999999 27140 OSTEOTOMY AND TRANSFER OF GREATER TROCHANTER $826.65 20060701 99999999 27146 OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE $918.92 20060701 99999999 27147 OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE $1,123.29 20060701 99999999 27151 OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE $1,103.46 20060701 99999999 27156 OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE $1,293.93 20060701 99999999 27158 OSTEOTOMY, PELVIS, BILATERAL FOR CONGENITAL MALFORMATION $1,016.80 20060701 99999999 27161 OSTEOTOMY, FEMORAL NECK (SEPARATE PROCEDURE) $930.77 20060701 99999999 27165 OSTEOTOMY, INTERTROCHANTERIC OR SUBTROCHANTERIC INCLUDING $1,015.63 20060701 99999999 27170 BONE GRAFT FOR NONUNION, FEMORAL HEAD, NECK, $941.75 20060701 99999999 27175 TREATMENT OF SLIPPED FEMORAL EPIPHYSIS $388.67 20060701 99999999 27176 TREATMENT OF SLIPPED FEMORAL EPIPHYSIS $660.06 20060701 99999999 27177 OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS $807.96 20060701 99999999 27178 OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS $658.20 20060701 99999999 27179 OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS $713.19 20060701 99999999 27181 OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS $775.26 20060701 99999999 27185 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, $443.51 20060701 99999999 27187 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) $833.15 20060701 99999999 27193 CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; $276.94 20060701 99999999 27194 CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; $454.55 20060701 99999999 27200 TREATMENT OF CLOSED COCCYGEAL FRACTURE $102.21 20060701 99999999 27202 OPEN TREATMENT OF CLOSED OR OPEN COCCYGEAL FRACTURE $607.12 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 125
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