Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 43200 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $86.70 20060701 99999999 43201 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUB $95.64 20060701 99999999 43202 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $100.09 20060701 99999999 43204 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $195.97 20060701 99999999 43205 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BAND LIGATION OF ESOPHAGEAL VARICES $171.61 20060701 99999999 43215 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $137.74 20060701 99999999 43216 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER L $125.73 20060701 99999999 43217 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $151.24 20060701 99999999 43219 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $147.00 20060701 99999999 43220 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $109.66 20060701 99999999 43226 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $121.78 20060701 99999999 43227 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $187.19 20060701 99999999 43228 ESOPHAGOSCOPY, RIGID OR FLEXIBLE FIBEROPTIC (SPECIFY) $197.10 20060701 99999999 43231 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION $134.11 20060701 99999999 43232 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMU $185.05 20060701 99999999 43234 UPPER GASTROINTESTINAL ENDOSCOPY, SIMPLE PRIMARY EXAMINATION $105.06 20060701 99999999 43235 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $124.03 20060701 99999999 43236 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $117.71 20060701 99999999 43237 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $161.96 20060701 99999999 43238 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $200.41 20060701 99999999 43239 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $139.60 20060701 99999999 43240 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $273.09 20060701 99999999 43241 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $134.79 20060701 99999999 43242 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $273.59 20060701 99999999 43243 UPPER GI ENDOSCOPY INCL ESOPHAGUS STOMACH AND DUODE OR JEJUN $237.05 20060701 99999999 43244 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $211.38 20060701 99999999 43245 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $176.43 20060701 99999999 43246 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $225.63 20060701 99999999 43247 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $176.43 20060701 99999999 43248 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $163.68 20060701 99999999 43249 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $150.36 20060701 99999999 43250 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $166.50 20060701 99999999 43251 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $192.26 20060701 99999999 43255 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $227.96 20060701 99999999 43256 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $173.16 20060701 99999999 43257 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE $225.19 20060701 99999999 43258 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, $236.46 20060701 99999999 43259 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DU $230.07 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 168
PROC-CODE DESC MAC BEG END 43260 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), $299.02 20060701 99999999 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); 43261 WITH BIOPSY, SINGLE OR MU $309.24 20060701 99999999 43262 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), $383.44 20060701 99999999 43263 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), $304.33 20060701 99999999 43264 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), $446.70 20060701 99999999 ERCP W/WO BIOP AND/OR COLLECTION OF SPECIMEN FOR 43265 DESTRUCTION $410.83 20060701 99999999 43267 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), $371.28 20060701 99999999 43268 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), $383.13 20060701 99999999 ERCP W/WO BIOP AND OR COLL OF SPECIMEN FOR REMOVAL AND/OR 43269 CH $313.23 20060701 99999999 43271 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), $374.21 20060701 99999999 43272 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), $339.90 20060701 99999999 43280 LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURE $837.01 20060701 99999999 43300 ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION) $543.59 20060701 99999999 43305 ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION) $912.90 20060701 99999999 43310 ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION) THORACIC APPROACH $1,307.79 20060701 99999999 43312 ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION) THORACIC APPROACH $1,427.88 20060701 99999999 43313 ESOPHAGOPLASTY FOR CONGENITAL DEFECT, (PLASTIC REPAIR OR RECONSTRUCTION), THORAC $1,939.44 20060701 99999999 43314 ESOPHAGOPLASTY FOR CONGENITAL DEFECT, (PLASTIC REPAIR OR RECONSTRUCTION), THORAC $2,131.62 20060701 99999999 43320 ESOPHAGOGASTROSTOMY (CARDIOPLASTY) WITH OR WITHOUT VAGOTOMY $832.04 20060701 99999999 43324 ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, BELSEY IV, HILL PROCEDURES) $816.32 20060701 99999999 43325 ESOPHAGOGASTRIC FUNDOPLASTY WITH FUNDIC PATCH (THAL- NISSEN $804.91 20060701 99999999 43326 ESOPHAGOGASTRIC FUNDOPLASTY; WITH GASTROPLASTY (EG, COLLIS) $760.18 20060701 99999999 43330 ESOPHAGOMYOTOMY ((HELLER TYPE) WITH OR WITHOUT $788.67 20060701 99999999 43331 ESOPHAGOMYOTOMY ((HELLER TYPE) WITH OR WITHOUT $886.90 20060701 99999999 43340 ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY) $828.26 20060701 99999999 43341 ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY) $867.72 20060701 99999999 43350 ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL $629.35 20060701 99999999 43351 ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL $753.65 20060701 99999999 43352 ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL $661.05 20060701 99999999 43360 GASTROINTESTINAL RECONSTRUCTION FOR PREVIOUS ESOPHAGECTOMY, FOR OBSTRUCTING ESOP $1,455.90 20060701 99999999 43361 GASTROINTESTINAL RECONSTRUCTION FOR PREVIOUS ESOPHAGECTOMY, FOR OBSTRUCTING ESOP $1,661.05 20060701 99999999 43400 LIGATION, DIRECT, ESOPHAGEAL VARICES $802.37 20060701 99999999 43401 TRANSECTION OF ESOPHAGUS WITH REPAIR, FOR ESOPHAGEAL VARICES $823.13 20060701 99999999 43405 LIGATION OR STAPLING AT GASTROESOPHAGEAL JUNCTION FOR PRE- EXISTING ESOPHAGEAL PE $853.40 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 169
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