Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 27640 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR $732.60 20060701 99999999 27641 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR $602.73 20060701 99999999 27645 RESECTION FOR TUMOR, RADICAL $844.88 20060701 99999999 27646 RESECTION FOR TUMOR, RADICAL $789.95 20060701 99999999 27647 RESECTION FOR TUMOR, RADICAL $673.88 20060701 99999999 27648 INJECTION PROCEDURE FOR ANKLE ARTHROGRAPHY $39.92 20060701 99999999 27650 REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON $563.24 20060701 99999999 27652 REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON $606.10 20060701 99999999 27654 REPAIR, SECONDARY, RUPTURED ACHILLES TENDON, $609.96 20060701 99999999 27656 REPAIR, FASCIAL DEFECT OF LEG $281.61 20060701 99999999 27658 REPAIR OR SUTURE OF FLEXOR TENDON OF LEG $329.70 20060701 99999999 27659 REPAIR OR SUTURE OF FLEXOR TENDON OF LEG $422.47 20060701 99999999 27664 REPAIR OR SUTURE OF EXTENSOR TENDON OF LEG $307.34 20060701 99999999 27665 REPAIR OR SUTURE OF EXTENSOR TENDON OF LEG $365.90 20060701 99999999 27675 REPAIR FOR DISLOCATING PERONEAL TENDONS $425.80 20060701 99999999 27676 REPAIR FOR DISLOCATING PERONEAL TENDONS $494.61 20060701 99999999 27680 TENOLYSIS, INCLUDING TIBIA, FIBULA AND ANKLE FLEXOR $339.55 20060701 99999999 27681 TENOLYSIS, INCLUDING TIBIA, FIBULA AND ANKLE FLEXOR $411.71 20060701 99999999 27685 LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE $365.66 20060701 99999999 27686 LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE $459.37 20060701 99999999 27687 GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE) $383.46 20060701 99999999 27690 TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE $489.33 20060701 99999999 27691 TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE $575.65 20060701 99999999 27692 TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE $102.31 20060701 99999999 27695 SUTURE, PRIMARY, TORN, RUPTURED OR SEVERED LIGAMENT, $430.99 20060701 99999999 27696 SUTURE, PRIMARY, TORN, RUPTURED OR SEVERED LIGAMENT, $492.11 20060701 99999999 27698 SUTURE, SECONDARY REPAIR, TORN, RUPTURED OR SEVERED $573.94 20060701 99999999 27700 ARTHROPLASTY, ANKLE $542.19 20060701 99999999 27702 ARTHROPLASTY, ANKLE $830.46 20060701 99999999 27703 ARTHROPLASTY, ANKLE $862.38 20060701 99999999 27704 REMOVAL OF ANKLE IMPLANT $443.11 20060701 99999999 27705 OSTEOTOMY $640.92 20060701 99999999 27707 OSTEOTOMY $318.71 20060701 99999999 27709 OSTEOTOMY $628.29 20060701 99999999 27712 OSTEOTOMY $791.47 20060701 99999999 27715 OSTEOPLASTY, TIBIA AND FIBULA, LENGTHENING $831.90 20060701 99999999 27720 REPAIR OF NONUNION OR MALUNION, TIBIA $897.06 20060701 99999999 27722 REPAIR OF NONUNION OR MALUNION, TIBIA $697.86 20060701 99999999 27724 REPAIR OF NONUNION OR MALUNION, TIBIA $911.50 20060701 99999999 27725 REPAIR OF NONUNION OR MALUNION, TIBIA $844.40 20060701 99999999 27726 REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION $455.21 20080101 99999999 27727 REPAIR OF CONGENITAL PSEUDARTHROSIS, TIBIA $756.14 20060701 99999999 27730 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING $408.16 20060701 99999999 27732 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING $341.04 20060701 99999999 27734 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING $497.01 20060701 99999999 27740 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, $544.44 20060701 99999999 27742 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, $591.57 20060701 99999999 27745 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) $610.87 20060701 99999999 27750 TREATMENT OF CLOSED TIBIAL SHAFT FRACTURE $205.49 20060701 99999999 27752 TREATMENT OF CLOSED TIBIAL SHAFT FRACTURE $341.45 20060701 99999999 27756 OPEN TREATMENT OF CLOSED OR OPEN TIBIAL SHAFT $464.49 20060701 99999999 27758 OPEN TREATMENT OF CLOSED OR OPEN TIBIAL SHAFT $726.16 20060701 99999999 27759 OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY IN $819.11 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 130
PROC-CODE DESC MAC BEG END 27760 TREATMENT OF CLOSED DISTAL TIBIAL FRACTURE $168.46 20060701 99999999 27762 TREATMENT OF CLOSED DISTAL TIBIAL FRACTURE $288.36 20060701 99999999 27766 OPEN TREATMENT OF CLOSED OR OPEN DISTAL TIBIAL $492.00 20060701 99999999 27767 CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITHOUT MANIPULATION $133.50 20080101 99999999 27768 CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION $201.54 20080101 99999999 27769 OPEN TREATMENT OF POSTERIOR MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN $342.85 20080101 99999999 27780 TREATMENT OF CLOSED PROXIMAL FIBULA OR SHAFT $149.36 20060701 99999999 27781 TREATMENT OF CLOSED PROXIMAL FIBULA OR SHAFT $248.39 20060701 99999999 27784 OPEN TREATMENT OF CLOSED OR OPEN PROXIMAL FIBULA $416.55 20060701 99999999 27786 TREATMENT OF CLOSED DISTAL FIBULAR FRACTURE $157.64 20060701 99999999 27788 TREATMENT OF CLOSED DISTAL FIBULAR FRACTURE $232.65 20060701 99999999 27792 OPEN TREATMENT OF CLOSED OR OPEN DISTAL FIBULAR $458.47 20060701 99999999 27808 TREATMENT OF CLOSED BIMALLEOLAR ANKLE FRACTURE, $190.58 20060701 99999999 27810 TREATMENT OF CLOSED BIMALLEOLAR ANKLE FRACTURE, $313.58 20060701 99999999 27814 OPEN TREATMENT OF CLOSED OR OPEN BIMALLEOLAR $629.86 20060701 99999999 27816 TREATMENT OF CLOSED TRIMALLEOLAR ANKLE FRACTURE $199.34 20060701 99999999 27818 TREATMENT OF CLOSED TRIMALLEOLAR ANKLE FRACTURE $343.72 20060701 99999999 27822 OPEN TREATMENT OF CLOSED OR OPEN TRIMALLEOLAR $903.66 20060701 99999999 27823 OPEN TREATMENT OF CLOSED OR OPEN TRIMALLEOLAR $1,027.55 20060701 99999999 27824 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA $198.09 20060701 99999999 27825 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA $378.23 20060701 99999999 27826 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTA $734.66 20060701 99999999 27827 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTA $1,129.61 20060701 99999999 27828 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTA $1,265.82 20060701 99999999 27829 OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, WITH OR WI $517.10 20060701 99999999 27830 TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT $218.73 20060701 99999999 27831 TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT $269.07 20060701 99999999 27832 OPEN TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT $401.47 20060701 99999999 27840 TREATMENT OF ANKLE DISLOCATION $242.22 20060701 99999999 27842 TREATMENT OF ANKLE DISLOCATION $289.47 20060701 99999999 27846 OPEN TREATMENT OF CLOSED OR OPEN ANKLE DISLOCATION $568.00 20060701 99999999 27848 OPEN TREATMENT OF CLOSED OR OPEN ANKLE DISLOCATION $881.98 20060701 99999999 27860 MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA $136.89 20060701 99999999 27870 ARTHRODESIS, ANKLE, ANY METHOD $823.12 20060701 99999999 27871 ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL $547.56 20060701 99999999 27880 AMPUTATION LEG, THROUGH TIBIA AND FIBULA $654.00 20060701 99999999 27881 AMPUTATION LEG, THROUGH TIBIA AND FIBULA $725.91 20060701 99999999 27882 AMPUTATION LEG, THROUGH TIBIA AND FIBULA $555.49 20060701 99999999 27884 AMPUTATION LEG, THROUGH TIBIA AND FIBULA $443.28 20060701 99999999 27886 AMPUTATION LEG, THROUGH TIBIA AND FIBULA $540.05 20060701 99999999 27888 AMPUTATION, ANKLE, THROUGH MALLEOLI OF TIBIA AND $592.29 20060701 99999999 27889 ANKLE DISARTICULATION $567.48 20060701 99999999 27892 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY, WITH D $384.82 20060701 99999999 27893 DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY, WITH DEBRIDEMENT O $370.71 20060701 99999999 27894 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMEN $506.24 20060701 99999999 28001 INCISION AND DRAINAGE, INFECTED BURSA, FOOT $123.13 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 131
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Medicaid Fee Schedule without Mods 200801

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