Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 28002 DEEP DISSECTION BELOW FASCIA, FOR DEEP INFECTION OF FOOT, $227.84 20060701 99999999 28003 DEEP DISSECTION BELOW FASCIA, FOR DEEP INFECTION OF FOOT, $402.52 20060701 99999999 28005 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR $452.49 20060701 99999999 28008 FASCIOTOMY, PLANTAR AND/OR TOE, SUBCUTANEOUS $250.24 20060701 99999999 28010 TENOTOMY, SUBCUTANEOUS, TOE $171.50 20060701 99999999 28011 TENOTOMY, SUBCUTANEOUS, TOE $220.76 20060701 99999999 28020 ARTHROTOMY, WITH EXPLORATION, DRAINAGE OR REMOVAL $301.48 20060701 99999999 28022 ARTHROTOMY, WITH EXPLORATION, DRAINAGE OR REMOVAL $231.78 20060701 99999999 28024 ARTHROTOMY, WITH EXPLORATION, DRAINAGE OR REMOVAL $220.58 20060701 99999999 28030 NEURECTOMY OF INTRINSIC MUSCULATURE OF FOOT $288.69 19990701 99999999 28035 TARSAL TUNNEL RELEASE (POSTERIOR TIBIAL NERVE DECOMPRESSION) $312.26 20060701 99999999 28043 EXCISION, TUMOR, FOOT $193.49 20060701 99999999 28045 EXCISION, TUMOR, FOOT $274.19 20060701 99999999 28046 RAD RESECT TUMOR SOFT TISSUE FOOT (EG MALIG NEOPLASM) $518.60 20060701 99999999 28050 ARTHROTOMY FOR SYNOVIAL BIOPSY $256.08 20060701 99999999 28052 ARTHROTOMY FOR SYNOVIAL BIOPSY $219.92 20060701 99999999 28054 ARTHROTOMY FOR SYNOVIAL BIOPSY $220.00 20060701 99999999 28055 NEURECTOMY, INTRINSIC MUSCULATURE OF FOOT $271.10 20070101 99999999 28060 FASCIECTOMY, EXCISION OF PLANTAR FASCIA $302.77 20060701 99999999 28062 FASCIECTOMY, EXCISION OF PLANTAR FASCIA $384.31 20060701 99999999 28070 SYNOVECTOMY $299.10 20060701 99999999 28072 SYNOVECTOMY $275.51 20060701 99999999 28080 EXCISION OF INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH $237.64 20060701 99999999 28086 SYNOVECTOMY, TENDON SHEATH, FOOT $296.63 20060701 99999999 28088 SYNOVECTOMY, TENDON SHEATH, FOOT $258.49 20060701 99999999 28090 EXCISION OF LESION OF TENDON OR FIBROUS SHEATH OR $245.38 20060701 99999999 28092 EXCISION OF LESION OF TENDON OR FIBROUS SHEATH OR $212.58 20060701 99999999 28100 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $338.68 20060701 99999999 28102 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $453.82 20060701 99999999 28103 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $365.28 20060701 99999999 28104 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $307.68 20060701 99999999 28106 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $410.03 20060701 99999999 28107 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $331.91 20060701 99999999 28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN $218.47 20060701 99999999 28110 OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL $262.02 20060701 99999999 28111 OSTECTOMY, COMPLETE EXCISION $324.19 20060701 99999999 28112 OSTECTOMY, COMPLETE EXCISION $287.23 20060701 99999999 28113 OSTECTOMY, COMPLETE EXCISION $299.12 20060701 99999999 28114 OSTECTOMY, COMPLETE EXCISION $578.20 20060701 99999999 28116 OSTECTOMY, EXCISION OF TARSAL COALITION $400.10 20060701 99999999 28118 OSTECTOMY, CALCANEUS $357.86 20060701 99999999 28119 OSTECTOMY, CALCANEUS $321.08 20060701 99999999 28120 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, $357.85 20060701 99999999 28122 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, $403.29 20060701 99999999 28124 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, $264.02 20060701 99999999 28126 CONDYLECTOMY, PHALANGEAL BASE, SINGLE TOE, EACH $217.46 20060701 99999999 28130 TALECTOMY (ASTRAGALECTOMY) $471.12 20060701 99999999 28140 METATARSECTOMY $381.57 20060701 99999999 28150 PHALANGECTOMY OF TOE, SINGLE, EACH $259.42 20060701 99999999 28153 RESECTION, HEAD OF PHALANX, TOE $204.31 20060701 99999999 28160 HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, $229.00 20060701 99999999 28171 RADICAL RESECTION FOR TUMOR $508.61 20060701 99999999 28173 RADICAL RESECTION FOR TUMOR $463.31 20060701 99999999 28175 RADICAL RESECTION FOR TUMOR $349.11 20060701 99999999 28190 REMOVAL OF FOREIGN BODY, FOOT $105.05 20060701 99999999 28192 REMOVAL OF FOREIGN BODY, FOOT $235.60 20060701 99999999 28193 REMOVAL OF FOREIGN BODY, FOOT $285.12 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 132
PROC-CODE DESC MAC BEG END 28200 REPAIR OR SUTURE OF TENDON, FOOT, FLEXOR, SINGLE $296.79 20060701 99999999 28202 REPAIR OR SUTURE OF TENDON, FOOT, FLEXOR, SINGLE $381.33 20060701 99999999 28208 REPAIR OR SUTURE OF TENDON, FOOT, EXTENSOR, SINGLE $244.71 20060701 99999999 28210 REPAIR OR SUTURE OF TENDON, FOOT, EXTENSOR, SINGLE $362.63 20060701 99999999 28220 TENOLYSIS, FLEXOR, FOOT $236.50 20060701 99999999 28222 TENOLYSIS, FLEXOR, FOOT $302.55 20060701 99999999 28225 TENOLYSIS, EXTENSOR, FOOT $213.60 20060701 99999999 28226 TENOLYSIS, EXTENSOR, FOOT $264.38 20060701 99999999 28230 TENOTOMY, OPEN, FLEXOR $225.06 20060701 99999999 28232 TENOTOMY, OPEN, FLEXOR $189.97 20060701 99999999 28234 TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE $179.52 20060701 99999999 28238 ADVANCEMENT OF POSTERIOR TIBIAL TENDON WITH $440.12 20060701 99999999 28240 TENOTOMY LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE $238.46 20060701 99999999 28250 DIVISION OF PLANTAR FASCIA AND MUSCLE (''STEINDLER $336.59 20060701 99999999 28260 CAPSULOTOMY, MIDFOOT $395.28 20060701 99999999 28261 CAPSULOTOMY, MIDFOOT $559.57 20060701 99999999 28262 CAPSULOTOMY, MIDFOOT $857.87 20060701 99999999 28264 CAPSULOTOMY, MIDTARSAL (HEYMAN TYPE PROCEDURE) $590.51 20060701 99999999 28270 CAPSULOTOMY FOR CONTRACTURE $245.55 20060701 99999999 28272 CAPSULOTOMY FOR CONTRACTURE $190.84 20060701 99999999 28280 WEBBING OPERATION (CREATE SYNDACTYLISM OF TOES) $275.10 20060701 99999999 28285 HAMMERTOE OPERATION $285.98 20060701 99999999 28286 HAMMERTOE OPERATION $268.04 20060701 99999999 28288 OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, $299.55 20060701 99999999 28289 HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF $325.22 20060701 99999999 28290 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY $363.19 20060701 99999999 28292 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY $415.47 20060701 99999999 28293 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY $522.40 20060701 99999999 28294 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY $496.32 20060701 99999999 28296 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY $521.64 20060701 99999999 28297 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY $544.86 20060701 99999999 28298 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY $478.20 20060701 99999999 28299 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY $522.47 20060701 99999999 28300 OSTEOTOMY $513.63 20030401 99999999 28302 OSTEOTOMY $554.04 20060701 99999999 28304 OSTEOTOMY, MIDTARSAL BONES, OTHER THAN CALCANEUS OR TALUS $475.77 20060701 99999999 28305 OSTEOTOMY, MIDTARSAL BONES, OTHER THAN CALCANEUS OR TALUS $609.06 20060701 99999999 28306 OSTEOTOMY, METATARSAL, BASE OR SHAFT, SINGLE, WITH OR WITHOUT $326.41 20060701 99999999 28307 OSTEOTOMY METATARSAL BASE OR SHAFT SINGLE W/WO LENGTHENING $394.86 20060701 99999999 28308 OSTEOTOMY, METATARSAL, BASE OR SHAFT, SINGLE, WITH OR WITHOUT $313.26 20060701 99999999 28309 OSTEOTOMY, METATARSALS, MULTIPLE, FOR CAVUS FOOT $622.16 20060701 99999999 28310 OSTEOTOMY FOR SHORTENING, ANGULAR OR ROTATIONAL $308.71 20060701 99999999 28312 OSTEOTOMY FOR SHORTENING, ANGULAR OR ROTATIONAL $298.91 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 133
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Medicaid Fee Schedule without Mods 200801

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