Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 36425 VENIPUNCTURE, CUTDOWN $38.50 20060701 99999999 36430 TRANSFUSION, BLOOD OR BLOOD COMPONENTS $33.38 20060701 99999999 36440 PUSH TRANSFUSION, BLOOD, 2 YEARS OR UNDER $49.88 20060701 99999999 36450 EXCHANGE TRANSFUSION, BLOOD $105.23 20060701 99999999 36455 EXCHANGE TRANSFUSION, BLOOD $120.47 20060701 99999999 36460 TRANSFUSION, INTRAUTERINE, FETAL $304.16 20060701 99999999 36470 INJECTION OF SCLEROSING SOLUTION $45.53 20060701 99999999 36471 INJECTION OF SCLEROSING SOLUTION $63.59 20060701 99999999 36475 ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL $268.80 20060701 99999999 36476 ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL $131.03 20060701 99999999 36478 ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL $268.80 20060701 99999999 36479 ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL $131.03 20060701 99999999 36481 PERCUTANEOUS PORTAL VEIN CATHETERIZATION BY ANY METHOD $316.84 20060701 99999999 36488 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, $61.36 19990701 99999999 36489 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, $58.69 20030401 99999999 36490 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, $79.33 19990701 99999999 36491 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, $74.89 19990701 99999999 36493 REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GU $49.56 19990701 99999999 36500 VENOUS CATHETERIZATION FOR SELECTIVE ORGAN BLOOD SAMPLING $118.46 20060701 99999999 36510 CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, $42.29 20060701 99999999 36511 THERAPEUTIC APHERESIS; FOR WHITE BLOOD CELLS $68.11 20060701 99999999 36512 THERAPEUTIC APHERESIS; FOR RED BLOOD CELLS $68.11 20060701 99999999 36513 THERAPEUTIC APHERESIS; FOR PLATELETS $68.11 20060701 99999999 36514 THERAPEUTIC APHERESIS; FOR PLASMA PHERESIS $68.11 20060701 99999999 36515 THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL IMMUNOADSORPTION AND PLASMA REINFUSIO $68.11 20060701 99999999 36516 THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL SELECTIVE ADSORPTION OR SELECTIVE FIL $68.11 20060701 99999999 36520 THERAPEUTIC APHERESIS (PLASMA AND/OR CELL EXCHANGE) $90.71 19990701 99999999 36521 THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL AFFINITY COLUMN ADSORPTION AND PLASMA $68.31 20000101 99999999 36522 PHOTOPHERESIS EXTRACORPOREAL $89.42 20060701 99999999 36530 INSERTION OF IMPLANTABLE INTRAVENOUS INFUSION PUMP $315.24 19990701 99999999 36531 REVISION OF IMPLANTABLE INTRAVENOUS INFUSION PUMP $265.19 19990701 99999999 36532 REMOVAL OF IMPLANTABLE INTRAVENOUS INFUSION PUMP $150.00 19990701 99999999 36533 INSERTION OF IMPLANTABLE VENOUS ACCESS PORT, WITH OR WITHOUT SUBCUTANEOUS RESERV $276.54 20030401 99999999 36534 REVISION OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR $151.86 19990701 99999999 36535 REMOVAL OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR $125.70 20030401 99999999 36536 MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH) FROM $143.91 20030401 99999999 36537 MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM CEN $35.27 20030401 99999999 36550 DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER $23.95 20000101 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 158
PROC-CODE DESC MAC BEG END 36555 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; UNDER 5 YE $83.45 20060701 99999999 36556 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEAR $79.28 20060701 99999999 36557 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUT $227.75 20060701 99999999 36558 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUT $216.36 20060701 99999999 36560 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBC $270.15 20060701 99999999 36561 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBC $260.70 20060701 99999999 36563 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE WITH SUBCU $271.38 20060701 99999999 36565 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, REQUIRING $260.70 20060701 99999999 36566 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, REQUIRING $279.29 20060701 99999999 36568 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCU $74.05 20060701 99999999 36569 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCU $69.67 20060701 99999999 36570 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEO $235.48 20060701 99999999 36571 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEO $234.64 20060701 99999999 36575 REPAIR OF TUNNELED OR NON-TUNNELED CENTRAL VENOUS ACCESS CATHETER, WITHOUT SUBCU $36.89 20060701 99999999 36576 REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL $151.90 20060701 99999999 36578 REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS P $173.25 20060701 99999999 36580 REPLACEMENT, COMPLETE, OF A NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHE $51.12 20060701 99999999 36581 REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, $160.76 20060701 99999999 36582 REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DE $235.88 20060701 99999999 36583 REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DE $237.52 20060701 99999999 36584 REPLACEMENT, COMPLETE, OF A PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC) $52.10 20060701 99999999 36585 REPLACEMENT, COMPLETE, OF A PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, $220.90 20060701 99999999 36589 REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP $109.12 20060701 99999999 36590 REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP $147.28 20060701 99999999 36591 COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE $12.68 20080101 99999999 36592 COLLECTION OF BLOOD SPECIMEN USING ESTABLISHED CENTRAL OR PERIPHERAL CATHETER, V $15.71 20080101 99999999 36593 DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER $19.39 20080101 99999999 36595 MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH) FROM $146.77 20060701 99999999 36596 MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM CEN $36.06 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 159
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Medicaid Fee Schedule without Mods 200801

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