Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 27427 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE $580.51 20060701 99999999 27428 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE $820.50 20060701 99999999 27429 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE $817.42 20060701 99999999 27430 QUADRICEPS PLASTY (BENNETT OR THOMPSON TYPE) $573.52 20060701 99999999 27435 CAPSULOTOMY, KNEE, POSTERIOR CAPSULAR RELEASE $527.24 20060701 99999999 27437 ARTHROPLASTY, PATELLA $534.30 20060701 99999999 27438 ARTHROPLASTY, PATELLA $692.99 20060701 99999999 27440 ARTHROPLASTY, KNEE, TIBIAL PLATEAU $639.55 20060701 99999999 27441 ARTHROPLASTY, KNEE, TIBIAL PLATEAU $609.60 20060701 99999999 27442 ARTHROPLASTY, KNEE, FEMORAL CONDYLES OR TIBIAL PLATEAUS $726.15 20060701 99999999 27443 ARTHROPLASTY, KNEE, FEMORAL CONDYLES OR TIBIAL PLATEAUS $674.68 20060701 99999999 27445 ARTHROPLASTY, KNEE, CONSTRAINED PROSTHESIS (EG, WALLDIUS TYPE) $1,049.75 20060701 99999999 27446 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU $960.00 20060701 99999999 27447 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU $1,492.58 20060701 99999999 27448 OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR $690.14 20060701 99999999 27450 OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR $852.53 20060701 99999999 27454 OSTEOTOMY, MULTIPLE, FEMORAL SHAFT, WITH REALIGNMENT $983.71 20060701 99999999 27455 OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR $750.00 20060701 99999999 27457 OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR $782.81 20060701 99999999 27465 OSTEOPLASTY, FEMUR $811.59 20060701 99999999 27466 OSTEOPLASTY, FEMUR $931.62 20060701 99999999 27468 OSTEOPLASTY, FEMUR $1,039.36 20060701 99999999 27470 REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO $975.79 20060701 99999999 27472 REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO $1,082.92 20060701 99999999 27475 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING $507.16 20060701 99999999 27477 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING $611.06 20060701 99999999 27479 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING $725.29 20060701 99999999 27485 ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL $516.30 20060701 99999999 27486 REVISION OF TOTAL KNEE ARTHROPLASTY $1,149.06 20060701 99999999 27487 REVISION OF TOTAL KNEE ARTHROPLASTY $1,483.24 20060701 99999999 27488 REMOVAL OF KNEE PROSTHESIS, INCLUDING 'TOTAL KNEE' $932.68 20060701 99999999 27495 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) $961.48 20060701 99999999 27496 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR EXTENSOR $365.40 20060701 99999999 27497 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR EXTENSOR $422.68 20060701 99999999 27498 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS; $452.58 20060701 99999999 27499 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS; WITH DEBRIDE $504.67 20060701 99999999 27500 TREATMENT OF CLOSED FEMORAL SHAFT FRACTURE (INCLUDING $361.95 20060701 99999999 27501 CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITH $375.61 20060701 99999999 27502 TREATMENT OF CLOSED FEMORAL SHAFT FRACTURE (INCLUDING $586.07 20060701 99999999 27503 CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITH $587.63 20060701 99999999 27506 OPEN TREATMENT OF CLOSED OR OPEN FEMORAL SHAFT $982.50 20060701 99999999 27507 OPEN TREATMENT OF FEMORAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERC $842.51 20060701 99999999 27508 TREATMENT OF CLOSED FEMORAL FRACTURE, DISTAL END, $316.30 20060701 99999999 27509 PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTUR $417.25 20060701 99999999 27510 TREATMENT OF CLOSED FEMORAL FRACTURE, DISTAL END, $484.58 20060701 99999999 27511 OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERC $833.16 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 128
PROC-CODE DESC MAC BEG END 27513 OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITH INTERCOND $1,008.97 20060701 99999999 27514 OPEN TREATMENT OF CLOSED OR OPEN FEMORAL FRACTURE, $973.63 20060701 99999999 27516 TREATMENT OF CLOSED DISTAL FEMORAL EPIPHYSEAL SEPARATION $381.15 20060701 99999999 27517 TREATMENT OF CLOSED DISTAL FEMORAL EPIPHYSEAL SEPARATION $495.63 20060701 99999999 27519 OPEN TREATMENT OF CLOSED OR OPEN DISTAL $846.67 20060701 99999999 27520 TREATMENT OF CLOSED PATELLAR FRACTURE, WITHOUT MANIPULATION $161.38 20060701 99999999 27524 OPEN TREATMENT OF CLOSED OR OPEN PATELLAR FRACTURE, $589.94 20060701 99999999 27530 TREATMENT OF CLOSED TIBIAL FRACTURE, PROXIMAL (PLATEAU) $227.14 20060701 99999999 27532 TREATMENT OF CLOSED TIBIAL FRACTURE, PROXIMAL (PLATEAU) $390.49 20060701 99999999 27535 OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, WITH OR WITH $698.67 20060701 99999999 27536 OPEN TREATMENT OF CLOSED OR OPEN TIBIAL FRACTURE, $822.41 20060701 99999999 27538 TREATMENT OF CLOSED INTERCONDYLAR SPINE(S) $274.74 20060701 99999999 27540 OPEN TREATMENT OF CLOSED OR OPEN INTERCONDYLAR $711.79 20060701 99999999 27550 TREATMENT OF CLOSED KNEE DISLOCATION $290.62 20060701 99999999 27552 TREATMENT OF CLOSED KNEE DISLOCATION $395.00 20060701 99999999 27556 OPEN TREATMENT OF CLOSED OR OPEN KNEE DISLOCATION, $830.62 20060701 99999999 27557 OPEN TREATMENT OF CLOSED OR OPEN KNEE DISLOCATION, $956.30 20060701 99999999 27558 OPEN TREATMENT OF KNEE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATIO $986.12 20060701 99999999 27560 TREATMENT OF CLOSED PATELLAR DISLOCATION $190.64 20060701 99999999 27562 TREATMENT OF CLOSED PATELLAR DISLOCATION $332.45 20060701 99999999 27566 OPEN TREATMENT OF CLOSED OR OPEN PATELLAR $674.98 20060701 99999999 27570 MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA $120.79 20060701 99999999 27580 FUSION OF KNEE, ANY TECHNIQUE $1,059.00 20060701 99999999 27590 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL $684.13 20060701 99999999 27591 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL $767.73 20060701 99999999 27592 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL $590.54 20060701 99999999 27594 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL $386.79 20060701 99999999 27596 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL $601.26 20060701 99999999 27598 DISARTICULATION AT KNEE $633.72 20060701 99999999 27600 FASCIOTOMY, LEG, FOR CLOSED SPACE DECOMPRESSION $337.14 20060701 99999999 27601 FASCIOTOMY, LEG, FOR CLOSED SPACE DECOMPRESSION $338.18 20060701 99999999 27602 FASCIOTOMY, LEG, FOR CLOSED SPACE DECOMPRESSION $399.31 20060701 99999999 27603 INCISION AND DRAINAGE, LEG OR ANKLE $320.62 20060701 99999999 27604 INCISION AND DRAINAGE, LEG OR ANKLE $246.35 20060701 99999999 27605 TENOTOMY, ACHILLES TENDON, SUBCUTANEOUS (SEPARATE $156.77 20060701 99999999 27606 TENOTOMY, ACHILLES TENDON, SUBCUTANEOUS (SEPARATE $224.58 20060701 99999999 27607 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR $526.69 20060701 99999999 27610 ARTHROTOMY, ANKLE, FOR INFECTION, WITH EXPLORATION, DRAINAGE OR $505.00 20060701 99999999 27612 ARTHROTOMY, ANKLE, POSTERIOR CAPSULAR RELEASE, $456.94 20060701 99999999 27613 BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA $107.14 20060701 99999999 27614 BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA $297.78 20060701 99999999 27615 RAD RESECT TUMOR SOFT TISSUE OF LEG OR ANKLE AREA $715.15 20060701 99999999 27618 EXCISION, TUMOR, LEG OR ANKLE AREA $270.11 20060701 99999999 27619 EXCISION, TUMOR, LEG OR ANKLE AREA $433.53 20060701 99999999 27620 ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR $383.36 20060701 99999999 27625 ARTHROTOMY, ANKLE, FOR SYNOVECTOMY $518.66 20060701 99999999 27626 ARTHROTOMY, ANKLE, FOR SYNOVECTOMY $562.80 20060701 99999999 27630 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE $281.06 20060701 99999999 27635 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, $510.59 20060701 99999999 27637 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, $598.59 20060701 99999999 27638 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, $635.32 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 129
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