Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 29425 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) $44.99 20060701 99999999 29435 APPLICATION OF PATELLAR TENDON BEARING (PTB) CAST $54.10 20060701 99999999 29440 ADDING WALKER TO PREVIOUSLY APPLIED CAST $22.43 20060701 99999999 29445 APPLICATION OF RIGID TOTAL CONTACT LEG CAST $91.09 20060701 99999999 29450 APPLICATION OF CLUBFOOT CAST WITH MOLDING OR $79.98 20060701 99999999 29505 APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES) $33.01 20060701 99999999 29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) $29.94 20060701 99999999 29520 STRAPPING $24.76 20060701 99999999 29530 STRAPPING $24.67 20060701 99999999 29540 STRAPPING $20.58 20060701 99999999 29550 STRAPPING $18.91 20060701 99999999 29580 STRAPPING $23.14 20060701 99999999 29590 DENIS-BROWNE SPLINT STRAPPING $27.80 20060701 99999999 29700 REMOVAL OR BIVALVING $22.74 20060701 99999999 29705 REMOVAL OR BIVALVING $29.80 20060701 99999999 29710 REMOVAL OR BIVALVING $51.99 20060701 99999999 29715 REMOVAL OR BIVALVING $39.10 20060701 99999999 29720 REPAIR OF SPICA, BODY CAST OR JACKET $27.58 20060701 99999999 29730 WINDOWING OF CAST $28.61 20060701 99999999 29740 WEDGING OF CAST (EXCEPT CLUBFOOT CASTS) $42.21 20060701 99999999 29750 WEDGING OF CLUBFOOT CAST $49.33 20060701 99999999 29800 ARTHROSCOPY,TEMPOROMANDIBULAR JOINT,DIAG,WITH OR W/OUT SYNOV $364.88 20060701 99999999 29804 ARTHROSCOPY,TEMPOROMANDIBULAR JOINT,SURGICAL $511.05 20060701 99999999 29805 ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PRO $296.67 20060701 99999999 29806 ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY $749.02 20060701 99999999 29807 ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION $728.89 20060701 99999999 29815 ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY $354.79 19990701 99999999 29819 ARTHROSCOPY, SHOULDER, SURGICAL $493.91 20060701 99999999 29820 ARTHROSCOPY, SHOULDER, SURGICAL $469.76 20060701 99999999 29821 ARTHROSCOPY, SHOULDER, SURGICAL $497.79 20060701 99999999 29822 ARTHROSCOPY, SHOULDER, SURGICAL $489.96 20060701 99999999 29823 ARTHROSCOPY, SHOULDER, SURGICAL $528.66 20060701 99999999 29824 ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULA $458.72 20060701 99999999 29825 ARTHROSCOPY, SHOULDER, SURGICAL $495.15 20060701 99999999 29826 ARTHROSCOPY SHOULDER SURG DECOMPRESSION OF SUBACROMIAL SPACE $575.82 20060701 99999999 29827 ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR $790.52 20060701 99999999 29828 ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS $456.26 20080101 99999999 29830 ARTHROSCOPY, ELBOW, DIAGNOSTIC, WITH OR WITHOUT $339.28 20060701 99999999 29834 ARTHROSCOPY, ELBOW, SURGICAL $376.86 20060701 99999999 29835 ARTHROSCOPY, ELBOW, SURGICAL $389.48 20060701 99999999 29836 ARTHROSCOPY, ELBOW, SURGICAL $440.36 20060701 99999999 29837 ARTHROSCOPY, ELBOW, SURGICAL $406.61 20060701 99999999 29838 ARTHROSCOPY, ELBOW, SURGICAL $446.88 20060701 99999999 29840 ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOP (SEP PROCEDURE) $322.26 20060701 99999999 29843 ARTHROSCOPY WRIST SURG FOR INFECTION/LAVAGE AND DRAINAGE $378.05 20060701 99999999 29844 ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL $398.38 20060701 99999999 29845 ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE $452.04 20060701 99999999 29846 ARTHROSCOPY WRIST SURG EXC TRIANGULAR FIBROCARTILAGE JNT DEB $469.88 20060701 99999999 29847 ARTHROSCOPY WRIST SURG INT FIX FOR FX OR INSTABILITY $483.68 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 136
PROC-CODE DESC MAC BEG END 29848 ARTHROSCOPY, WRIST, SURGICAL; WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT $329.23 20060701 99999999 29850 ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRA $488.43 20060701 99999999 29851 ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRA $733.38 20060701 99999999 29855 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICOND $655.16 20060701 99999999 29856 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDY $794.44 20060701 99999999 29860 ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE $422.32 20060701 99999999 29861 ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY $549.15 20060701 99999999 29862 ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHO $588.73 20060701 99999999 29863 ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY $570.02 20060701 99999999 29866 ARTHROSCOPY, KNEE, SURGICAL; OSTEOCHONDRAL AUTOGRAFT(S) (EG, MOSAICPLASTY) $777.30 20060701 99999999 29867 ARTHROSCOPY, KNEE, SURGICAL; OSTEOCHONDRAL ALLOGRAFT (EG, MOSAICPLASTY) $927.86 20060701 99999999 29868 ARTHROSCOPY, KNEE, SURGICAL; MENISCAL TRANSPLANTATION (INCLUDES ARTHROTOMY FOR $1,251.04 20060701 99999999 29870 ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY $298.03 20060701 99999999 29871 ARTHROSCOPY, KNEE, SURGICAL $411.39 20060701 99999999 29873 ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE $369.85 20060701 99999999 29874 ARTHROSCOPY, KNEE, SURGICAL $440.53 20060701 99999999 29875 ARTHROSCOPY, KNEE, SURGICAL $402.16 20060701 99999999 29876 ARTHROSCOPY, KNEE, SURGICAL $498.56 20060701 99999999 29877 ARTHROSCOPY, KNEE, SURGICAL $460.73 20060701 99999999 29879 ARTHROSCOPY, KNEE, SURGICAL $498.98 20060701 99999999 29880 ARTHROSCOPY, KNEE, SURGICAL $525.43 20060701 99999999 29881 ARTHROSCOPY, KNEE, SURGICAL $483.75 20060701 99999999 29882 ARTHROSCOPY, KNEE, SURGICAL $532.76 20060701 99999999 29883 ARTHROSCOPY KNEE SURG W/MENISCUS REPAIR (MEDIAL&LATERAL) $578.53 20060701 99999999 29884 ARTHROSCOPY, KNEE, SURGICAL $470.87 20060701 99999999 29885 ARTHROSCOPY KNEE SURG DRILLING FOR OSTEOCHONDRITIS DISSECANS $539.35 20060701 99999999 29886 ARTHROSCOPY, KNEE, SURGICAL $452.51 20060701 99999999 29887 ARTHROSCOPY, KNEE, SURGICAL $563.67 20060701 99999999 29888 ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/ $842.13 20060701 99999999 29889 ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR $806.54 20060701 99999999 29891 ARTHROSCOPY, ANKLE, SURGICAL; EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR T $517.99 20060701 99999999 29892 ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION, TALAR D $542.76 20060701 99999999 29893 ENDOSCOPIC PLANTAR FASCIOTOMY $306.63 20060701 99999999 29894 ARTHROSCOPY, ANKLE, SURGICAL $450.22 20060701 99999999 29895 ARTHROSCOPY, ANKLE, SURGICAL $443.19 20060701 99999999 29897 ARTHROSCOPY, ANKLE, SURGICAL $457.68 20060701 99999999 29898 ARTHROSCOPY, ANKLE, SURGICAL $510.07 20060701 99999999 29899 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH ANKLE ART $725.35 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 137
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