Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 44050 REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL $548.52 20060701 99999999 44055 CORRECTION OF MALROTATION BY LYSIS OF DUODENAL $775.86 20060701 99999999 44100 BIOPSY OF INTESTINE BY CAPSULE, TUBE, PERORAL $91.02 20060701 99999999 44110 EXCISION OF ONE OR MORE LESIONS OF SMALL OR LARGE $500.46 20060701 99999999 44111 EXCISION OF ONE OR MORE LESIONS OF SMALL OR LARGE $615.84 20060701 99999999 44120 ENTERECTOMY, RESECTION OF SMALL INTESTINE $901.47 20060701 99999999 44121 ENTERECTOMY, RESECTION OF SMALL INTESTINE; EACH ADDITIONAL RESECTION AND ANASTOM $193.63 20060701 99999999 44125 ENTERECTOMY, RESECTION OF SMALL INTESTINE $722.71 20060701 99999999 44126 ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE RESECTI $1,458.50 20060701 99999999 44127 ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE RESECTI $1,676.62 20060701 99999999 44128 ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE RESECTI $177.56 20060701 99999999 44130 ENTEROENTEROSTOMY, ANASTOMOSIS OF INTESTINE $596.93 20060701 99999999 44139 MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIA $97.26 20060701 99999999 44140 COLECTOMY, PARTIAL $1,036.36 20060701 99999999 44141 COLECTOMY, PARTIAL $947.85 20060701 99999999 44143 COLECTOMY, PARTIAL $978.26 20060701 99999999 44144 COLECTOMY, PARTIAL $918.50 20060701 99999999 44145 COLECTOMY, PARTIAL $1,062.19 20060701 99999999 44146 COLECTOMY, PARTIAL $1,171.58 20060701 99999999 44147 COLECTOMY, PARTIAL $929.29 20060701 99999999 44150 COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY $1,062.07 20060701 99999999 44151 COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY $1,015.93 20060701 99999999 44152 COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY $1,205.97 19990701 99999999 44153 COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY $1,348.11 19990701 99999999 44155 COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY $1,206.77 20060701 99999999 44156 COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY $1,154.86 20060701 99999999 44157 COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOANAL ANASTOMOSIS, INCLUD $1,395.74 20070101 99999999 44158 COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOANAL ANASTOMOSIS, CREATI $1,431.30 20070101 99999999 44160 COLECTOMY WITH REMOVAL OF TERMINAL ILEUM AND ILEOCOLOSTOMY $789.34 20060701 99999999 44180 LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PR $580.32 20060701 99999999 44186 LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING) $409.43 20060701 99999999 44187 LAPAROSCOPY, SURGICAL; ILEOSTOMY OR JEJUNOSTOMY, NON- TUBE $678.17 20060701 99999999 44188 LAPAROSCOPY, SURGICAL, COLOSTOMY OR SKIN LEVEL CECOSTOMY $742.92 20060701 99999999 44200 LAPAROSCOPY, SURGICAL; ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PR $662.36 20000101 99999999 44201 LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING) $426.38 20000101 99999999 44202 LAPAROSCOPY, SURGICAL; INTESTINAL RESECTION, WITH ANASTOMOSIS (INTRA OR EXTRACOR $1,015.83 20060701 99999999 44203 LAPAROSCOPY, SURGICAL; EACH ADDITIONAL SMALL INTESTINE RESECTION AND ANASTOMOSIS $172.29 20060701 99999999 44204 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS $997.92 20060701 99999999 44205 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH I $884.08 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 172
PROC-CODE DESC MAC BEG END 44206 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH END COLOSTOMY AND CLOSURE OF DIS $1,091.61 20060701 99999999 44207 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOM $1,193.10 20060701 99999999 44208 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOM $1,293.11 20060701 99999999 44210 LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY, WITH IL $1,145.17 20060701 99999999 44211 LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH ILEOA $1,422.83 20060701 99999999 44212 LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH ILEOS $1,329.66 20060701 99999999 44213 LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN $132.31 20060701 99999999 44227 LAPAROSCOPY, SURGICAL, CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE, WITH RE $1,042.35 20060701 99999999 44300 ENTEROSTOMY, OR CECOSTOMY, TUBE (EG, FOR DECOMPRESSION OR FEEDING) $445.37 20060701 99999999 44310 ILEOSTOMY $609.24 20060701 99999999 44312 REVISION OF ILEOSTOMY $300.83 20060701 99999999 44314 REVISION OF ILEOSTOMY $571.96 20060701 99999999 44316 CONTINENT ILEOSTOMY (KOCK PROCEDURE) $787.02 20060701 99999999 44320 COLOSTOMY OR SKIN LEVEL CECOSTOMY $658.30 20060701 99999999 44322 COLOSTOMY OR SKIN LEVEL CECOSTOMY $653.91 20060701 99999999 44340 REVISION OF COLOSTOMY $302.07 20060701 99999999 44345 REVISION OF COLOSTOMY $562.12 20060701 99999999 44346 REVISION OF COLOSTOMY $613.08 20060701 99999999 44360 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND $148.89 20060701 99999999 44361 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND $163.43 20060701 99999999 44363 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND $180.86 20060701 99999999 44364 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND $210.68 20060701 99999999 44365 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT I $188.21 20060701 99999999 44366 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND $246.38 20060701 99999999 44369 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND $250.80 20060701 99999999 44370 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT I $180.27 20060701 99999999 44372 SMALL INTEST ENDOSCOPY ENTEROSCOPY BEYOND 2ND PORTION OF DUO $247.79 20060701 99999999 44373 SMALL INTEST ENDOSCOPY ENTEROSCOPY BEYOND 2ND PORTION DUODEN $198.18 20060701 99999999 44376 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLU $258.18 20060701 99999999 44377 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLU $270.79 20060701 99999999 44378 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLU $346.40 20060701 99999999 44379 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLU $280.59 20060701 99999999 44380 FIBEROPTIC ILEOSCOPY THROUGH STOMA $65.56 20060701 99999999 44382 FIBEROPTIC ILEOSCOPY THROUGH STOMA $78.05 20060701 99999999 44383 ILEOSCOPY, THROUGH STOMA; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDILA $121.52 20060701 99999999 44385 FIBEROPTIC EVALUATION OF SMALL INTESTINAL (KOCK) OR $94.81 20060701 99999999 44386 FIBEROPTIC EVALUATION OF SMALL INTESTINAL (KOCK) OR $97.78 20060701 99999999 44388 FIBEROPTIC COLONOSCOPY THROUGH COLOSTOMY $148.02 20060701 99999999 44389 FIBEROPTIC COLONOSCOPY THROUGH COLOSTOMY $163.35 20060701 99999999 44390 FIBEROPTIC COLONOSCOPY THROUGH COLOSTOMY $174.05 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 173
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