Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 29900 ARTHROSCOPY, METACARPOPHALANGEAL JOINT, DIAGNOSTIC, INCLUDES SYNOVIAL BIOPSY $328.10 20060701 99999999 29901 ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH DEBRIDEMENT $360.87 20060701 99999999 29902 ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH REDUCTION OF DISPLACED UL $386.80 20060701 99999999 29904 ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BOD $308.47 20080101 99999999 29905 ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH SYNOVECTOMY $333.14 20080101 99999999 29906 ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH DEBRIDEMENT $350.92 20080101 99999999 29907 ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH SUBTALAR ARTHRODESIS $427.07 20080101 99999999 30000 DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH $69.98 20060701 99999999 30020 DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM $72.00 20060701 99999999 30100 BIOPSY, INTRANASAL $43.47 20060701 99999999 30110 EXCISION, NASAL POLYP(S), SIMPLE $79.46 20060701 99999999 30115 EXCISION, NASAL POLYP(S), EXTENSIVE $252.65 20060701 99999999 30117 EXCISION, INTRANASAL LESION $194.16 20060701 99999999 30118 EXCISION, INTRANASAL LESION $528.83 20060701 99999999 30120 EXCISION OR SURGICAL PLANING OF SKIN OF NOSE FOR RHINOPHYMA $326.47 20060701 99999999 30124 EXCISION DERMOID CYST, NOSE $166.84 20060701 99999999 30125 EXCISION DERMOID CYST, NOSE $386.63 20060701 99999999 30130 EXCISION TURBINATE, PARTIAL OR COMPLETE $224.38 20060701 99999999 30140 SUBMUCOUS RESECTION TURBINATE, PARTIAL OR COMPLETE $241.40 20060701 99999999 30150 RHINECTOMY $510.57 20060701 99999999 30160 RHINECTOMY $569.04 20060701 99999999 30200 INJECTION INTO TURBINATE(S), THERAPEUTIC $37.61 20060701 99999999 30210 DISPLACEMENT THERAPY (PROETZ TYPE) $59.41 20060701 99999999 30220 INSERTION, NASAL SEPTAL PROSTHESIS (BUTTON) $76.03 20060701 99999999 30300 REMOVAL FOREIGN BODY, INTRANASAL $73.73 20060701 99999999 30310 REMOVAL FOREIGN BODY, INTRANASAL $126.27 20060701 99999999 30320 REMOVAL FOREIGN BODY, INTRANASAL $288.51 20060701 99999999 30400 RHINOPLASTY, PRIMARY $635.65 20060701 99999999 30410 RHINOPLASTY, PRIMARY $787.33 20060701 99999999 30420 RHINOPLASTY, PRIMARY $924.19 20060701 99999999 30430 RHINOPLASTY, SECONDARY $584.26 20060701 99999999 30435 RHINOPLASTY, SECONDARY $779.68 20060701 99999999 30450 RHINOPLASTY, SECONDARY $1,015.67 20060701 99999999 30460 RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, $553.36 20060701 99999999 30462 RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, $1,050.40 20060701 99999999 30465 REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL R $604.20 20060701 99999999 30520 SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE $347.70 20060701 99999999 30540 REPAIR CHOANAL ATRESIA $424.00 20060701 99999999 30545 REPAIR CHOANAL ATRESIA $634.64 20060701 99999999 30560 LYSIS INTRANASAL SYNECHIA $84.67 20060701 99999999 30580 REPAIR FISTULA $365.78 20060701 99999999 30600 REPAIR FISTULA $298.07 20060701 99999999 30620 RECONSTRUCTION, FUNCTIONAL, INTERNAL NOSE (SEPTAL OR OTHER $370.39 20060701 99999999 30630 REPAIR NASAL SEPTAL PERFORATIONS $404.60 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 138
PROC-CODE DESC MAC BEG END 30801 CAUTERIZATION AND/OR ABLATION, MUCOSA OF TURBINATES, UNILATERAL OR BILATERAL, AN $75.30 20060701 99999999 30802 CAUTERIZATION AND/OR ABLATION, MUCOSA OF TURBINATES, UNILATERAL OR BILATERAL, AN $110.57 20060701 99999999 30901 CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (CAUTERIZATION) $44.33 20060701 99999999 30903 CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (CAUTERIZATION WITH LOCAL $65.99 20060701 99999999 30905 CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL $98.64 20060701 99999999 30906 CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL $107.34 20060701 99999999 30915 LIGATION ARTERIES $384.00 20060701 99999999 30920 LIGATION ARTERIES $559.08 20060701 99999999 30930 FRACTURE NASAL TURBINATE(S), THERAPEUTIC $74.71 20060701 99999999 31000 LAVAGE BY CANNULATION $63.28 20060701 99999999 31002 LAVAGE BY CANNULATION $128.48 20060701 99999999 31020 SINUSOTOMY, MAXILLARY (ANTROTOMY) $203.83 20060701 99999999 31030 SINUSOTOMY, MAXILLARY (ANTROTOMY) $344.95 20060701 99999999 31032 SINUSOTOMY, MAXILLARY (ANTROTOMY) $393.24 20060701 99999999 31040 PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH $497.21 20060701 99999999 31050 SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY $318.37 20060701 99999999 31051 SINUSOTOMY SPHENOID W/WO BIOP W/MUCOSAL STRIPPING OR REMOVAL $425.74 20060701 99999999 31070 SINUSOTOMY FRONTAL $267.60 20060701 99999999 31075 SINUSOTOMY FRONTAL $546.24 20060701 99999999 31080 SINUSOTOMY FRONTAL $625.70 20060701 99999999 31081 SINUSOTOMY FRONTAL $698.44 20060701 99999999 31084 SINUSOTOMY FRONTAL $785.82 20060701 99999999 31085 SINUSOTOMY FRONTAL $830.43 20060701 99999999 31086 SINUSOTOMY FRONTAL $697.73 20060701 99999999 31087 SINUSOTOMY FRONTAL $692.37 20060701 99999999 31090 SINUSOTOMY COMBINED, THREE OR MORE SINUSES $571.27 20060701 99999999 31200 ETHMOIDECTOMY $352.05 20060701 99999999 31201 ETHMOIDECTOMY $463.02 20060701 99999999 31205 ETHMOIDECTOMY $549.83 20060701 99999999 31225 MAXILLECTOMY $1,090.57 20060701 99999999 31230 MAXILLECTOMY $1,235.15 20060701 99999999 31231 NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE) $63.70 20060701 99999999 31233 NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY (VIA INFERIOR MEATU $104.79 20060701 99999999 31235 NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF SPH $118.58 20060701 99999999 31237 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARA $137.94 20060701 99999999 31238 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF EPISTAXIS $151.74 20060701 99999999 31239 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY $504.10 20060701 99999999 31240 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION $144.92 20060701 99999999 31254 NASAL ENDOSCOPY SURG W/ETHMOIDECTOMY PARTIAL $259.80 20060701 99999999 31255 NASAL ENDOSCOPY SURG W/ETHMOIDECTOMY ANTER & POSTER TOTAL $389.35 20060701 99999999 31256 NASAL ENDOSCOPY SURGICAL W/MAXILLARY ANTROSTOMY $184.03 20060701 99999999 31267 MAXILLARY SINUS ENDOSCOPY SURG W/REMOVAL MUCOUS MEMBRANE $292.23 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 139
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Medicaid Fee Schedule without Mods 200801

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