Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 33786 TOTAL REPAIR, TRUNCUS ARTERIOSUS (RASTELLI TYPE OPERATION) $1,917.76 20060701 99999999 33788 REPLANT PULMONARY ARTERY FOR HEMITRUNCUS $1,478.20 20060701 99999999 33800 AORTIC SUSPENSION (AORTOPEXY) FOR TRACHEAL DECOMPRESSION (EG, FOR TRACHEOMALACIA $991.04 20060701 99999999 33802 DIVISION OF ABERRANT VESSEL (VASCULAR RING) $1,105.90 20060701 99999999 33803 DIVISION OF ABERRANT VESSEL (VASCULAR RING) $1,128.00 20060701 99999999 33813 OBLITERATION AORTOPULMONARY SEPTAL DEFECT W/O CARDIOPULM BYP $1,252.92 20060701 99999999 33814 OBLIT AORTOPULM SEPTAL DEFECT W/CARDIOPULM BYPASS $1,587.67 20060701 99999999 33820 PATENT DUCTUS ARTERIOSUS $1,036.76 20060701 99999999 33822 PATENT DUCTUS ARTERIOSUS $1,007.55 20060701 99999999 33824 PATENT DUCTUS ARTERIOSUS $1,225.40 20060701 99999999 33840 EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED $1,282.33 20060701 99999999 33845 EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED $1,382.19 20060701 99999999 33851 EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED $1,350.69 20060701 99999999 33852 EXC COARCTATION OF AORTA W/WO ASSOCIATED PATENT DUCTUS ARTER $1,443.82 20060701 99999999 33853 REPAIR OF HYPOPLASTIC OR INTERRUPTED AORTIC ARCH USING AUTOGENOUS OR PROSTHETIC $1,963.33 20060701 99999999 33860 ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, $1,964.91 20060701 99999999 33861 ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT VALVE SUSPEN $1,979.23 20060701 99999999 33863 ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT VALVE SUSPEN $2,049.34 20060701 99999999 33864 ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS WITH VALVE SUSPENSION, WITH C $1,647.47 20080101 99999999 33870 TRANSVERSE ARCH GRAFT, WITH CARDIOPULMONARY BYPASS $2,349.71 20060701 99999999 33875 DESCENDING THORACIC AORTA GRAFT, WITH OR WITHOUT BYPASS $1,851.62 20060701 99999999 33877 REPAIR THORACOABDOMINAL AORTIC ANEURYSM W/GRAFT W/WO CARDIOP $2,429.32 20060701 99999999 33880 ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM, $1,275.48 20060701 99999999 33881 ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM, $1,096.96 20060701 99999999 33883 PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING $810.68 20060701 99999999 33884 PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING $298.70 20060701 99999999 33886 PLACEMENT OF DISTAL EXTENSION PROSTHESIS(S) DELAYED AFTER ENDOVASCULAR REPAIR OF $701.04 20060701 99999999 33889 OPEN SUBCLAVIAN TO CAROTID ARTERY TRANSPOSITION PERFORMED IN CONJUNCTION WITH EN $595.15 20060701 99999999 33891 BYPASS GRAFT, WITH OTHER THAN VEIN, TRANSCERVICAL RETROPHARYNGEAL CAROTID-CAROTI $760.49 20060701 99999999 33910 PULMONARY ARTERY EMBOLECTOMY $1,269.60 20060701 99999999 33915 PULMONARY ARTERY EMBOLECTOMY $1,009.35 20060701 99999999 33916 PULM ENDARTERECTOMY W/WO EMBOLECTOMY W/CARDIOPULM BYPASS $1,339.99 20060701 99999999 33917 REPAIR OF PULMONARY ARTERY STENOSIS BY RECONSTRUCTION WITH PATCH OR GRAFT $1,522.81 20060701 99999999 33918 REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT, BY UNIFOCALIZATION O $1,512.96 19990701 99999999 33919 REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT, BY UNIFOCALIZATION O $1,849.59 19990701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 150
PROC-CODE DESC MAC BEG END 33920 REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT, BY CONSTRUCTION OR R $1,907.94 20060701 99999999 33922 TRANSECTION OF PULMONARY ARTERY WITH CARDIOPULMONARY BYPASS $1,421.98 20060701 99999999 33924 LIGATION AND TAKEDOWN OF A SYSTEMIC-TO-PULMONARY ARTERY SHUNT, PERFORMED IN CONJ $266.67 20060701 99999999 33925 REPAIR OF PULMONARY ARTERY ARBORIZATION ANOMALIES BY UNIFOCALIZATION; WITHOUT CA $1,257.56 20060701 99999999 33926 REPAIR OF PULMONARY ARTERY ARBORIZATION ANOMALIES BY UNIFOCALIZATION; WITH CARDI $1,693.36 20060701 99999999 33935 HEART-LUNG TRANSPLANT WITH RECIPIENT CARDIECTOMY- PNEUMONECTOMY $3,491.81 20060701 99999999 33945 HEART TRANSPLANT, WITH OR WITHOUT RECIPIENT CARDIECTOMY $2,463.46 20060701 99999999 33960 PROLONGED EXTRACORPOREAL CIRCULATION FOR $761.08 20060701 99999999 33961 PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; EACH ADD $505.50 20060701 99999999 33967 INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS $190.78 20060701 99999999 33968 REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS $31.43 20060701 99999999 33970 INTRA-AORTIC BALLOON COUNTERPULSATION $361.17 20060701 99999999 33971 INTRA-AORTIC BALLOON COUNTERPULSATION $531.88 20060701 99999999 33973 INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE ASCENDING AORTA $480.21 20060701 99999999 33974 REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE FROM THE ASCENDING AORTA, INCLUDIN $725.10 20060701 99999999 33975 IMPLANTATION OF VENTRICULAR ASSIST DEVICE; SINGLE VENTRICLE SUPPORT $1,082.61 20060701 99999999 33976 IMPLANTATION OF VENTRICULAR ASSIST DEVICE; BIVENTRICULAR SUPPORT $1,231.77 20060701 99999999 33977 REMOVAL OF VENTRICULAR ASSIST DEVICE; SINGLE VENTRICLE SUPPORT $996.64 20060701 99999999 33978 REMOVAL OF VENTRICULAR ASSIST DEVICE; BIVENTRICULAR SUPPORT $1,119.97 20060701 99999999 33979 INSERTION OF VENTRICULAR ASSIST DEVICE, IMPLANTABLE INTRACORPOREAL, SINGLE VENTR $1,553.95 20060701 99999999 33980 REMOVAL OF VENTRICULAR ASSIST DEVICE, IMPLANTABLE INTRACORPOREAL, SINGLE VENTRIC $2,078.71 20060701 99999999 33999 UNLISTED PROCEDURE, CARDIAC SURGERY $971.74 19990701 99999999 34001 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER $644.59 20060701 99999999 34051 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER $718.63 20060701 99999999 34101 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER $511.52 20060701 99999999 34111 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER $429.91 20060701 99999999 34151 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER $898.46 20060701 99999999 34201 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER $499.51 20060701 99999999 34203 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER $623.47 20060701 99999999 34401 THROMBECTOMY, DIRECT OR WITH CATHETER $896.66 20060701 99999999 34421 THROMBECTOMY, DIRECT OR WITH CATHETER $498.02 20060701 99999999 34451 THROMBECTOMY, DIRECT OR WITH CATHETER $975.53 20060701 99999999 34471 THROMBECTOMY, DIRECT OR WITH CATHETER $429.88 20060701 99999999 34490 THROMBECTOMY, DIRECT OR WITH CATHETER $426.14 20060701 99999999 34501 VALVULOPLASTY, FEMORAL VEIN $622.73 20060701 99999999 34502 RECONSTRUCTION OF VENA CAVA, ANY METHOD $1,299.23 20060701 99999999 34510 VENOUS VALVE TRANSPOSITION, ANY VEIN DONOR $713.05 20060701 99999999 34520 CROSS-OVER VEIN GRAFT TO VENOUS SYSTEM $686.53 20060701 99999999 34530 SAPHENOPOPLITEAL VEIN ANASTOMOSIS $871.62 20060701 99999999 34800 ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION; USING $858.38 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 151
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