Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 32652 THORACOSCOPY, SURGICAL; WITH TOTAL PULMONARY DECORTICATION, INCLUDING INTRAPLEUR $1,039.64 20060701 99999999 32653 THORACOSCOPY, SURGICAL; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN DEPO $739.03 20060701 99999999 32654 THORACOSCOPY, SURGICAL; WITH CONTROL OF TRAUMATIC HEMORRHAGE $706.93 20060701 99999999 32655 THORACOSCOPY, SURGICAL; WITH EXCISION-PLICATION OF BULLAE, INCLUDING ANY PLEURAL $786.30 20060701 99999999 32656 THORACOSCOPY, SURGICAL; WITH PARIETAL PLEURECTOMY $793.67 20060701 99999999 32657 THORACOSCOPY, SURGICAL; WITH WEDGE RESECTION OF LUNG, SINGLE OR MULTIPLE $817.26 20060701 99999999 32658 THORACOSCOPY, SURGICAL; WITH REMOVAL OF CLOT OR FOREIGN BODY FROM PERICARDIAL SA $744.12 20060701 99999999 32659 THORACOSCOPY, SURGICAL; WITH CREATION OF PERICARDIAL WINDOW OR PARTIAL RESECTION $743.63 20060701 99999999 32660 THORACOSCOPY, SURGICAL; WITH TOTAL PERICARDECTOMY $1,077.56 20060701 99999999 32661 THORACOSCOPY, SURGICAL; WITH EXCISION OF PERICARDIAL CYST, TUMOR, OR MASS $751.23 20060701 99999999 32662 THORACOSCOPY, SURGICAL; WITH EXCISION OF MEDIASTINAL CYST, TUMOR, OR MASS $942.01 20060701 99999999 32663 THORACOSCOPY, SURGICAL; WITH LOBECTOMY, TOTAL OR SEGMENTAL $1,055.84 20060701 99999999 32664 THORACOSCOPY, SURGICAL; WITH THORACIC SYMPATHECTOMY $769.11 20060701 99999999 32665 THORACOSCOPY, SURGICAL; WITH ESOPHAGOMYOTOMY (HELLER TYPE) $877.00 20060701 99999999 32800 REPAIR LUNG HERNIA THROUGH CHEST WALL $750.84 20060701 99999999 32810 CLOSURE OF CHEST WALL FOLLOWING OPEN FLAP DRAINAGE FOR $695.69 20060701 99999999 32815 OPEN CLOSURE OF MAJOR BRONCHIAL FISTULA $1,228.13 20060701 99999999 32820 MAJOR RECONSTRUCTION, CHEST WALL (POST-TRAUMATIC) $1,190.57 20060701 99999999 32851 LUNG TRANSPLANT, SINGLE; WITHOUT CARDIOPULMONARY BYPASS $1,977.21 20060701 99999999 32852 LUNG TRANSPLANT, SINGLE; WITH CARDIOPULMONARY BYPASS $2,127.78 20060701 99999999 32853 LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUENTIAL OR EN BLOC); WITHOUT CARDIOPULMONA $2,412.20 20060701 99999999 32854 LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUENTIAL OR EN BLOC); WITH CARDIOPULMONARY $2,572.88 20060701 99999999 32900 RESECTION OF RIBS, EXTRAPLEURAL, ALL STAGES $972.55 20060701 99999999 32905 THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEURAL (ALL STAGES) $1,060.68 20060701 99999999 32906 THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEURAL (ALL STAGES) $1,337.48 20060701 99999999 32940 PNEUMONOLYSIS, EXTRAPERIOSTEAL, INCLUDING FILLING OR PACKING $992.74 20060701 99999999 32960 PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL INJECTION OF AIR $73.82 20060701 99999999 32997 TOTAL LUNG LAVAGE (UNILATERAL) $243.55 20060701 99999999 32998 ABLATION THERAPY FOR REDUCTION OR ERADICATION OF ONE OR MORE PULMONARY TUMOR(S) $196.01 20070101 99999999 32999 UNLISTED PROCEDURE, LUNGS AND PLEURA $205.69 19990701 99999999 33010 PERICARDIOCENTESIS $105.02 20060701 99999999 33011 PERICARDIOCENTESIS $97.60 20060701 99999999 33015 TUBE PERICARDIOSTOMY $355.09 20060701 99999999 33020 PERICARDIOTOMY FOR REMOVAL OF CLOT OR FOREIGN $763.83 20060701 99999999 33025 CREATION OF PERICARDIAL WINDOW OR PARTIAL RESECTION FOR DRAINAGE $757.17 20060701 99999999 33030 PARTIAL RESECTION FOR CHRONIC CONSTRICTIVE PERICARDITIS, $1,160.05 20060701 99999999 33031 COMPLT VENTRCLR DECRTCTN W/CARDPLMNRY BYPASS $1,163.58 20060701 99999999 33050 EXCISION OF PERICARDIAL CYST OR TUMOR $786.88 20060701 99999999 33120 EXCISION OF INTRACARDIAC TUMOR, RESECTION WITH $1,518.25 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 144
PROC-CODE DESC MAC BEG END 33130 RESECTION OF EXTERNAL CARDIAC TUMOR $1,109.81 20060701 99999999 33140 TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORACOTOMY (SEPARATE PROCEDURE) $1,000.66 20060701 99999999 33141 TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORACOTOMY; PERFORMED AT THE TIME O $185.47 20060701 99999999 33200 INSERTION OF PERMANENT PACEMAKER WITH EPICARDIAL $759.62 19990701 99999999 33201 INSERTION OF PERMANENT PACEMAKER WITH EPICARDIAL $687.92 19990701 99999999 33202 INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY, MEDIAN STE $534.75 20070101 99999999 33203 INSERTION OF EPICARDIAL ELECTRODE(S); ENDOSCOPIC APPROACH (EG, THORACOSCOPY, PER $548.53 20070101 99999999 33206 INSERTION OF PERMANENT PACEMAKER WITH TRANSVENOUS $417.10 20060701 99999999 33207 INSERTION OF PERMANENT PACEMAKER WITH TRANSVENOUS $488.48 20060701 99999999 33208 INSERTION OF PERMANENT PACEMAKER WITH TRANSVENOUS $526.97 20060701 99999999 33210 INSERTION OF TEMPORARY TRANSVENOUS CARDIAC ELECTRODE, $174.10 20060701 99999999 33211 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES $178.79 20060701 99999999 33212 INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR OR AUTOMATIC $331.18 20060701 99999999 33213 INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; DUAL CHAMBER $361.30 20060701 99999999 33214 UPGRADE OF IMPLANTED PACEMAKER SYSTEM, CONVERSION OF SINGLE CHAMBER SYSTEM TO DU $418.41 20060701 99999999 33215 REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR PACING CARDIOVERT $227.42 20060701 99999999 33216 INSERTION, REPLACEMENT, OR REPOSITIONING OF $329.06 20060701 99999999 33217 INSERTION, REPLACEMENT OR REPOSITIONING OF PERMANENT TRANSVENOUS ELECTRODE(S) ON $341.91 20060701 99999999 33218 REPAIR OF PACEMAKER $315.41 20060701 99999999 33220 REPAIR OF PACEMAKER ELECTRODE(S) ONLY; DUAL CHAMBER $318.39 20060701 99999999 33222 REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER OR AUTO $305.76 20060701 99999999 33223 REVISION OR RELOCATION OF SKIN POCKET FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR $377.65 20060701 99999999 33224 INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACIN $363.63 20060701 99999999 33225 INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACIN $320.77 20060701 99999999 33226 REPOSITIONING OF PREVIOUSLY IMPLANTED CARDIAC VENOUS SYSTEM (LEFT VENTRICULAR) E $350.25 20060701 99999999 33233 REMOVAL OF PERMANENT PACEMAKER; PULSE GENERATOR ONLY $208.64 20060701 99999999 33234 REMOVAL OF PERMANENT PACEMAKER; AND TRANSVENOUS ELECTRODE(S), SINGLE LEAD SYSTEM $379.03 20060701 99999999 33235 REMOVAL OF PERMANENT PACEMAKER; AND TRANSVENOUS ELECTRODE(S), DUAL LEAD SYSTEM $440.85 20060701 99999999 33236 REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; SINGLE $618.86 20060701 99999999 33237 REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; DUAL LE $761.98 20060701 99999999 33238 REMOVAL OF PERMANENT TRANSVENOUS ELECTRODE(S) BY THORACOTOMY $792.35 20060701 99999999 33240 INSERTION OR REPLACEMENT OF IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR PULSE GENERAT $416.09 20060701 99999999 33241 REMOVAL OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR ONLY $194.54 20060701 99999999 33242 REPAIR OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR AND/OR LEADS $335.39 19990701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 145
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