Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 31276 NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL SINUS EXPLORATION, WITH OR WITHOUT $442.35 20060701 99999999 31287 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; $219.33 20060701 99999999 31288 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM $256.10 20060701 99999999 31290 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK; ETHMOI $944.19 20060701 99999999 31291 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK; SPHENO $1,000.15 20060701 99999999 31292 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL OR INFERIOR ORBITAL WALL DECOMPRESS $796.88 20060701 99999999 31293 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL ORBITAL WALL AND INFERIOR ORBITAL W $868.03 20060701 99999999 31294 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH OPTIC NERVE DECOMPRESSION $1,021.29 20060701 99999999 31300 LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE) $842.27 20060701 99999999 31320 LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE) $389.30 20060701 99999999 31360 LARYNGECTOMY $1,064.35 20060701 99999999 31365 LARYNGECTOMY $1,457.92 20060701 99999999 31367 LARYNGECTOMY $1,239.76 20060701 99999999 31368 LARYNGECTOMY $1,612.33 20060701 99999999 31370 PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY) $1,226.14 20060701 99999999 31375 PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY) $1,112.30 20060701 99999999 31380 PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY) $1,156.09 20060701 99999999 31382 PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY) $1,182.54 20060701 99999999 31390 PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION $1,634.76 20060701 99999999 31395 PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION $1,916.47 20060701 99999999 31400 ARYTENOIDECTOMY OR ARYTENOIDOPEXY, EXTERNAL APPROACH $631.97 20060701 99999999 31420 EPIGLOTTIDECTOMY $632.40 20060701 99999999 31500 INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE $93.64 20060701 99999999 31502 TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TR $32.14 20060701 99999999 31505 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE) $30.26 20060701 99999999 31510 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE) $79.29 20060701 99999999 31511 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE) $90.36 20060701 99999999 31512 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE) $107.27 20060701 99999999 31513 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE) $117.65 20060701 99999999 31515 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY $81.56 20060701 99999999 31520 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY $120.53 20060701 99999999 31525 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY $115.20 20060701 99999999 31526 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY $143.56 20060701 99999999 31527 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY $168.53 20060701 99999999 31528 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY $130.81 20060701 99999999 31529 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY $139.85 20060701 99999999 31530 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL $183.54 20060701 99999999 31531 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL $201.10 20060701 99999999 31535 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY $176.24 20060701 99999999 31536 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY $199.06 20060701 99999999 31540 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING $230.97 20060701 99999999 31541 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING $245.74 20060701 99999999 31545 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH OPERATING MICROSCOPE OR TELESCOPE, WITH $286.01 20060701 99999999 31546 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH OPERATING MICROSCOPE OR TELESCOPE, WITH $434.40 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 140
PROC-CODE DESC MAC BEG END 31560 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY $286.93 20060701 99999999 31561 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY $328.97 20060701 99999999 31570 LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC $179.59 20060701 99999999 31571 LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC $234.90 20060701 99999999 31575 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC $53.40 20060701 99999999 31576 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC $109.05 20060701 99999999 31577 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC $136.25 20060701 99999999 31578 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC $147.42 20060701 99999999 31579 LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/STROBOSCOPY $103.09 20060701 99999999 31580 LARYNGOPLASTY $793.80 20060701 99999999 31582 LARYNGOPLASTY $1,218.78 20060701 99999999 31584 LARYNGOPLASTY $1,040.08 20060701 99999999 31585 TREATMENT OF CLOSED LARYNGEAL FRACTURE $311.31 19990701 99999999 31586 TREATMENT OF CLOSED LARYNGEAL FRACTURE $508.77 19990701 99999999 31587 LARYNGOPLASTY, CRICOID SPLIT $654.43 20060701 99999999 31588 LARYNGOPLASTY, NOT OTHERWISE SPECIFIED (EG, FOR BURNS, $785.51 20060701 99999999 31590 LARYNGEAL REINNERVATION BY NEUROMUSCULAR PEDICLE $567.92 20060701 99999999 31595 SECTION RECURRENT LARYNGEAL NERVE, THERAPEUTIC (SEPARATE $503.58 20060701 99999999 31600 TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE) $259.24 20060701 99999999 31601 TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE) $244.63 20060701 99999999 31603 TRACHEOSTOMY, EMERGENCY PROCEDURE $220.41 20060701 99999999 31605 TRACHEOSTOMY, EMERGENCY PROCEDURE $189.62 20060701 99999999 31610 TRACHEOSTOMY, FENESTRATION PROCEDURE WITH SKIN FLAPS $515.65 20060701 99999999 31611 CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND SUBQNT INSERTI $405.06 20060701 99999999 31612 TRACHEAL PUNCTURE, PERCUTANEOUS FOR ASPIRATION OF MUCUS $48.22 20060701 99999999 31613 TRACHEOSTOMA REVISION $294.72 20060701 99999999 31614 TRACHEOSTOMA REVISION $483.82 20060701 99999999 31615 TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTOMY INCISION $106.53 20060701 99999999 31620 ENDOBRONCHIAL ULTRASOUND (EBUS) DURING BRONCHOSCOPIC DIAGNOSTIC OR THERAPEUTIC $57.42 20060701 99999999 31622 BRONCHOSCOPY $142.83 20060701 99999999 31623 BRONCHOSCOPY; WITH BRUSHING OR PROTECTED BRUSHINGS $146.59 20060701 99999999 31624 BRONCHOSCOPY; WITH BRONCHIAL ALVEOLAR LAVAGE $146.59 20060701 99999999 31625 BRONCHOSCOPY $182.26 20060701 99999999 31628 BRONCHOSCOPY $192.38 20060701 99999999 31629 BRONCHOSCOPY $170.33 20060701 99999999 31630 BRONCHOSCOPY $197.31 20060701 99999999 31631 BRONCHOSCOPY $215.08 20060701 99999999 31632 BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH TRA $54.39 20060701 99999999 31633 BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH TRA $66.72 20060701 99999999 31635 BRONCHOSCOPY $192.10 20060701 99999999 31636 BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH $177.90 20060701 99999999 31637 BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; EACH $63.08 20060701 99999999 31638 BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH $198.19 20060701 99999999 31640 BRONCHOSCOPY $256.53 20060701 99999999 31641 BRONCHOSCOPY $260.69 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 141
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Medicaid Fee Schedule without Mods 200801

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