Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR 37735 SHORT $541.97 20060701 99999999 37760 LIGATION OF PERFORATORS, SUBFASCIAL, RADICAL (LINTON TYPE), $518.74 20060701 99999999 37765 STAB PHLEBECTOMY OF VARICOSE VEINS, ONE EXTREMITY; 10-20 STAB INCISIONS $328.08 20060701 99999999 37766 STAB PHLEBECTOMY OF VARICOSE VEINS, ONE EXTREMITY; MORE THAN 20 INCISIONS $419.22 20060701 99999999 37780 LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL $191.68 20060701 99999999 37785 LIGATION, DIVISION, AND/OR EXCISION OF SECONDARY VARICOSE $173.26 20060701 99999999 37788 PENILE REVASCULARIZATION, ARTERY, WITH OR WITHOUT VEIN GRAFT $1,056.31 20060701 99999999 37790 PENILE VENOUS OCCLUSIVE PROCEDURE $445.13 20060701 99999999 37799 UNLISTED PROCEDURE, VASCULAR SURGERY $475.92 19990701 99999999 38100 SPLENECTOMY (SEPARATE PROCEDURE) $618.85 20060701 99999999 38101 SPLENECTOMY (SEPARATE PROCEDURE) $620.36 20060701 99999999 38102 SPLENECTOMY; TOTAL, EN BLOC FOR EXTENSIVE DISEASE, IN CONJUNCTION WITH OTHER PRO $209.15 20060701 99999999 38115 REPAIR OF RUPTURED SPLEEN (SPLENORRHAPHY) WITH OR WITHOUT $645.06 20060701 99999999 38120 LAPAROSCOPY, SURGICAL, SPLENECTOMY $701.41 20060701 99999999 38200 INJECTION PROCEDURE FOR SPLENOPORTOGRAPHY $114.26 20060701 99999999 38205 BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER $58.87 20060701 99999999 38206 BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER $58.87 20060701 99999999 38220 BONE MARROW ASPIRATION $58.31 20060701 99999999 38221 BONE MARROW BIOPSY, NEEDLE OR TROCAR $73.80 20060701 99999999 38230 BONE MARROW HARVESTING FOR TRANSPLANTATION $209.12 20060701 99999999 38231 BLOOD-DERIVED PERIPHERAL STEM CELL HARVESTING FOR TRANSPLANTATION, PER COLLECTIO $73.72 19990701 99999999 38240 BONE MARROW TRANSPLANTATION $109.73 20060701 99999999 38241 BONE MARROW TRANSPLANTATION AUTOLOGOUS $109.48 20060701 99999999 38242 BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENEIC DO $67.10 20060701 99999999 38300 DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS $102.07 20060701 99999999 38305 DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS $265.31 20060701 99999999 38308 LYMPHANGIOTOMY OR OTHER OPERATIONS ON LYMPHATIC CHANNELS $274.83 20060701 99999999 38380 SUTURE AND/OR LIGATION OF THORACIC DUCT $405.33 20060701 99999999 38381 SUTURE AND/OR LIGATION OF THORACIC DUCT $697.46 20060701 99999999 38382 SUTURE AND/OR LIGATION OF THORACIC DUCT $510.16 20060701 99999999 38500 BIOPSY OR EXCISION OF LYMPH NODE(S) $147.18 20060701 99999999 38505 BIOPSY OR EXCISION OF LYMPH NODE(S) $57.20 20060701 99999999 38510 BIOPSY OR EXCISION OF LYMPH NODE(S) $247.97 20060701 99999999 38520 BIOPSY OR EXCISION OF LYMPH NODE(S) $277.45 20060701 99999999 38525 BIOPSY OR EXCISION OF LYMPH NODE(S) $236.41 20060701 99999999 38530 BIOPSY OR EXCISION OF LYMPH NODE(S) $332.24 20060701 99999999 38542 DISSECTION, DEEP JUGULAR NODE(S) $327.74 20060701 99999999 38550 EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL, WITHOUT DEEP $326.23 20060701 99999999 38555 EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL, WITHOUT DEEP $715.79 20060701 99999999 38562 LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE) $509.80 20060701 99999999 38564 LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE) $530.25 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 162
PROC-CODE DESC MAC BEG END 38570 LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE $442.74 20060701 99999999 38571 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY $573.92 20060701 99999999 38572 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORT $667.67 20060701 99999999 38700 SUPRAHYOID LYMPHADENECTOMY $567.88 20060701 99999999 38720 CERVICAL LYMPHADENECTOMY (COMPLETE) $868.60 20060701 99999999 38724 CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK $890.72 20060701 99999999 38740 AXILLARY LYMPHADENECTOMY $377.81 20060701 99999999 38745 AXILLARY LYMPHADENECTOMY $497.46 20060701 99999999 38746 THORACIC LYMPHADENECTOMY, REGIONAL, INCLUDING MEDIASTINAL AND PERITRACHEAL NODES $196.32 20060701 99999999 38747 ABDOMINAL LYMPHADENECTOMY, REGIONAL, INCLUDING CELIAC, PARA-AORTIC AND VENA CAVA $212.01 20060701 99999999 38760 INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, $481.70 20060701 99999999 38765 INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, IN $822.66 20060701 99999999 38770 PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, $718.11 20060701 99999999 38780 RETROPERITONEAL TRANSABDOMINAL LYMPHADENECTOMY, EXTENSIVE, $873.58 20060701 99999999 38790 INJECTION PROCEDURE FOR LYMPHANGIOGRAPHY $67.38 20060701 99999999 38792 INJECTION PROCEDURE; FOR IDENTIFICATION OF SENTINEL NODE $27.71 20060701 99999999 38794 CANNULATION, THORACIC DUCT $194.69 20060701 99999999 38999 UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM $274.25 19990701 99999999 39000 MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF $436.63 20060701 99999999 39010 MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF $746.97 20060701 99999999 39200 EXCISION OF MEDIASTINAL CYST $808.98 20060701 99999999 39220 EXCISION OF MEDIASTINAL TUMOR $994.77 20060701 99999999 39400 MEDIASTINOSCOPY, WITH OR WITHOUT BIOPSY $403.65 20060701 99999999 39501 REPAIR, LACERATION OF DIAPHRAGM $695.02 20060701 99999999 39502 REPAIR, PARAESOPHAGEAL HIATUS HERNIA, TRANSABDOMINAL, WITH OR $809.24 20060701 99999999 39503 REPAIR, NEONATAL DIAPHRAGMATIC HERNIA, INCLUDING CHEST $3,212.48 20060701 99999999 39520 REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL) $863.86 20060701 99999999 39530 REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL) $832.82 20060701 99999999 39531 REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL) $789.81 20060701 99999999 39540 REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC $730.00 20060701 99999999 39541 REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC $756.32 20060701 99999999 39545 IMBRICATION OF DIAPHRAGM FOR EVENTRATION $706.41 20060701 99999999 39560 RESECTION, DIAPHRAGM; WITH SIMPLE REPAIR (EG, PRIMARY SUTURE) $620.52 20060701 99999999 39561 RESECTION, DIAPHRAGM; WITH COMPLEX REPAIR (EG, PROSTHETIC MATERIAL, LOCAL MUSCLE $845.04 20060701 99999999 40490 BIOPSY OF LIP $49.51 20060701 99999999 40500 VERMILIONECTOMY (LIP SHAVE), WITH MUCOSAL ADVANCEMENT $273.21 20060701 99999999 40510 EXCISION OF LIP $304.17 20060701 99999999 40520 EXCISION OF LIP $294.72 20060701 99999999 40525 EXCISION OF LIP $465.16 20060701 99999999 40527 EXCISION OF LIP $554.16 20060701 99999999 40530 RESECTION OF LIP, MORE THAN ONE-FOURTH, WITHOUT RECONSTRUCTION $320.85 20060701 99999999 40650 REPAIR LIP, FULL THICKNESS $232.61 20060701 99999999 40652 REPAIR LIP, FULL THICKNESS $283.05 20060701 99999999 40654 REPAIR LIP, FULL THICKNESS $341.07 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 163
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