Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 33243 REMOVAL OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR AND/OR LEAD SY $1,040.77 20060701 99999999 33244 REMOVAL OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR AND/OR LEAD SY $704.61 20060701 99999999 33245 IMPLANTATION OF AUTOMATIC INTERNAL $911.56 19990701 99999999 33246 IMPLANT OF AUTOMATIC IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR $1,220.65 19990701 99999999 33247 INSERTION OR REPLACEMENT OF IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR LEAD(S), BY O $552.23 19990701 99999999 33249 INSERTION OR REPLACEMENT OF IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR LEAD(S), BY O $820.76 20060701 99999999 33250 OPERATIVE ABLATION SUPRAVENTRICULAR ARRHYTHMOGENIC FOCUS OR $1,071.50 20060701 99999999 33251 OPERATIVE ABLATION OF SUPRAVENTRICULAR ARRHYTHMOGENIC FOCUS $1,326.91 20060701 99999999 33253 OPERATIVE INCISIONS AND RECONSTRUCTION OF ATRIA FOR TREATMENT OF ATRIAL FIBRILLA $1,640.55 19990701 99999999 33254 OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, LIMITED (EG, MODIFIED MAZ $928.91 20070101 99999999 33255 OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTENSIVE (EG, MAZE PROCE $1,117.06 20070101 99999999 33256 OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTENSIVE (EG, MAZE PROCE $1,331.79 20070101 99999999 33257 OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF $313.67 20080101 99999999 33258 OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF $353.45 20080101 99999999 33259 OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF $462.14 20080101 99999999 33261 OPERATIVE ABLATION ARRHYTHMOGENIC FOCUS/PATHWAY W/CARDIOPULM $1,273.64 20060701 99999999 33265 ENDOSCOPY, SURGICAL; OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, LIMI $928.91 20070101 99999999 33266 ENDOSCOPY, SURGICAL; OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTE $1,267.31 20070101 99999999 33282 IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT RECORDER $309.84 20060701 99999999 33284 REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER $244.35 20060701 99999999 33300 REPAIR OF CARDIAC WOUND $1,015.32 20060701 99999999 33305 REPAIR OF CARDIAC WOUND $1,217.30 20060701 99999999 33310 CARDIOTOMY, EXPLORATORY (INCLUDES REMOVAL OF FOREIGN $1,012.78 20060701 99999999 33315 CARDIOTOMY, EXPLORATORY (INCLUDES REMOVAL OF FOREIGN $1,201.63 20060701 99999999 33320 SUTURE REPAIR OF AORTA OR GREAT VESSELS $957.41 20060701 99999999 33321 SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITH SHUNT BYPASS $1,226.68 20060701 99999999 33322 SUTURE REPAIR OF AORTA OR GREAT VESSELS $1,254.39 20060701 99999999 33330 INSERTION OF GRAFT, AORTA OR GREAT VESSELS $1,101.77 20060701 99999999 33332 INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITH SHUNT BYPASS $1,220.51 20060701 99999999 33335 INSERTION OF GRAFT, AORTA OR GREAT VESSELS $1,485.54 20060701 99999999 33400 VALVULOPLASTY, AORTIC VALVE, OPEN, WITH $1,557.77 20060701 99999999 33401 VALVULOPLASTY, AORTIC VALVE; OPEN, WITH INFLOW OCCLUSION $1,443.40 20060701 99999999 33403 VALVULOPLASTY, AORTIC VALVE; USING TRANSVENTRICULAR DILATION, WITH CARDIOPULMONA $1,536.42 20060701 99999999 33404 CONSTRUCTION OF APICAL-AORTIC CONDUIT $1,724.64 20060701 99999999 33405 REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS $1,772.14 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 146
PROC-CODE DESC MAC BEG END 33406 REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH HOMOGRAFT VALVE (FR $1,916.69 20060701 99999999 33410 REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH STENTLESS TISSUE VA $1,685.57 20060701 99999999 33411 REPLACEMENT, AORTIC VALVE $1,929.09 20060701 99999999 33412 REPLACEMENT, AORTIC VALVE $2,082.30 20060701 99999999 33413 REPLACEMENT, AORTIC VALVE; BY TRANSLOCATION OF AUTOLOGOUS PULMONARY VALVE WITH H $2,126.28 20060701 99999999 33414 REPAIR OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION BY PATCH ENLARGEMENT OF THE $1,867.92 20060701 99999999 33415 RESECTION OR INCISION OF SUBVALVULAR TISSUE FOR $1,640.02 20060701 99999999 33416 VENTRICULOMYOTOMY FOR IDIOPATHIC HYPERTROPHIC SUBAORTIC STEN $1,730.19 20060701 99999999 33417 AORTOPLASTY (GUSSET) FOR SUPRAVALVULAR STENOSIS $1,770.89 20060701 99999999 33420 VALVOTOMY, MITRAL VALVE (COMMISSUROTOMY) $1,152.46 20060701 99999999 33422 VALVOTOMY, MITRAL VALVE (COMMISSUROTOMY) $1,576.67 20060701 99999999 33425 VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS $1,602.41 20060701 99999999 33426 VALVULOPLASTY MITRAL VALVE W/CARDIOPULMONARY BYPASS W/PROSTH $1,813.38 20060701 99999999 33427 VALVULOPLASTY MITRAL VALVE W/CARDIOPULM BYPASS RAD RECONSTR $1,953.84 20060701 99999999 33430 REPLACEMENT, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS $2,030.56 20060701 99999999 33460 VALVULOPLASTY OR VALVECTOMY, TRICUSPID VALVE, WITH $1,437.01 20060701 99999999 33463 VALVULOPLASTY, TRICUSPID VALVE; WITHOUT RING INSERTION $1,553.28 20060701 99999999 33464 VALVULOPLASTY, TRICUSPID VALVE; WITH RING INSERTION $1,650.52 20060701 99999999 33465 VALVULOPLASTY OR VALVECTOMY, TRICUSPID VALVE, WITH $1,726.50 20060701 99999999 33468 TRICUSPID VALVE REPOSITIONING AND PLICATION FOR EBSTEIN ANOMALY $1,841.24 20060701 99999999 33470 VALVOTOMY, PULMONARY VALVE (COMMISSUROTOMY) $1,123.38 20060701 99999999 33471 VALVOTOMY, PULMONARY VALVE (COMMISSUROTOMY) $1,248.12 20060701 99999999 33472 VALVOTOMY, PULMONARY VALVE (COMMISSUROTOMY) $1,294.56 20060701 99999999 33474 VALVOTOMY, PULMONARY VALVE (COMMISSUROTOMY) $1,412.10 20060701 99999999 33475 REPLACEMENT, PULMONARY VALVE $1,728.81 20060701 99999999 33476 RIGHT VENTRICULAR RESECTION FOR INFUNDIBULAR $1,468.53 20060701 99999999 33478 OUTFLOW TRACT AUGMENTATION (GUSSET), WITH OR $1,650.24 20060701 99999999 33496 REPAIR OF NON-STRUCTURAL PROSTHETIC VALVE DYSFUNCTION WITH CARDIOPULMONARY BYPAS $1,680.98 20060701 99999999 33500 REPAIR CORONARY ARTERIOVENOUS OR ARTERIOCARDIC CHAMBER FISTU $1,536.67 20060701 99999999 33501 REPAIR OF CORONARY ARTERIOVENOUS OR ARTERIOCARDIAC CHAMBER FISTULA; WITHOUT CARD $996.55 20060701 99999999 33502 ANOMALOUS CORONARY ARTERY $1,253.87 20060701 99999999 33503 ANOMALOUS CORONARY ARTERY $1,276.79 20060701 99999999 33504 ANOMALOUS CORONARY ARTERY $1,531.03 20060701 99999999 33505 REPAIR OF ANOMALOUS CORONARY ARTERY; WITH CONSTRUCTION OF INTRAPULMONARY ARTERY $1,567.45 20060701 99999999 33506 REPAIR OF ANOMALOUS CORONARY ARTERY; BY TRANSLOCATION FROM PULMONARY ARTERY TO A $1,587.18 20060701 99999999 33507 REPAIR OF ANOMALOUS (EG, INTRAMURAL) AORTIC ORIGIN OF CORONARY ARTERY BY UNROOFI $1,230.45 20060701 99999999 33508 ENDOSCOPY, SURGICAL, INCLUDING VIDEO-ASSISTED HARVEST OF VEIN(S) FOR CORONARY AR $12.12 20060701 99999999 33510 CORONARY ARTERY BYPASS, AUTOGENOUS GRAFT, (EG, SAPHENOUS $1,525.90 20060701 99999999 33511 CORONARY ARTERY BYPASS, AUTOGENOUS GRAFT, (EG, SAPHENOUS $1,649.30 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 147
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