Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 44391 FIBEROPTIC COLONOSCOPY THROUGH COLOSTOMY $224.80 20060701 99999999 44392 FIBEROPTIC COLONOSCOPY THROUGH COLOSTOMY $199.85 20060701 99999999 44393 FIBEROPTIC COLONOSCOPY THROUGH COLOSTOMY $252.21 20060701 99999999 44394 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S $231.57 20060701 99999999 44397 COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDIL $189.99 20060701 99999999 44500 INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER- ABBOTT) (SEPARATE PROCEDU $21.51 20060701 99999999 44602 SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WO $566.18 20060701 99999999 44603 SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WO $661.26 20060701 99999999 44604 SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUN $649.54 20060701 99999999 44605 SUTURE OF INTESTINE (ENTERORRHAPHY), LARGE OR SMALL, FOR $718.40 20060701 99999999 44615 INTESTINAL STRICTUROPLASTY (ENTEROTOMY AND ENTERORRHAPHY) WITH OR WITHOUT DILATI $627.21 20060701 99999999 44620 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE $499.01 20060701 99999999 44625 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE $648.22 20060701 99999999 44626 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND COLORECTAL $997.19 20060701 99999999 44640 CLOSURE OF INTESTINAL CUTANEOUS FISTULA $761.46 20060701 99999999 44650 CLOSURE OF ENTEROENTERIC OR ENTEROCOLIC FISTULA $793.30 20060701 99999999 44660 CLOSURE OF ENTEROVESICAL FISTULA $737.38 20060701 99999999 44661 CLOSURE OF ENTEROVESICAL FISTULA $859.00 20060701 99999999 44680 INTESTINAL PLICATION (SEPARATE PROCEDURE) $668.61 20060701 99999999 44700 EXCLUSION OF SMALL BOWEL FROM PELVIS BY MESH OR OTHER PROSTHESIS, OR NATIVE TISS $712.41 20060701 99999999 44701 INTRAOPERATIVE COLONIC LAVAGE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P $118.35 20060701 99999999 44720 BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR INTESTINE ALLOGRAFT PRIOR $196.81 20050101 99999999 44721 BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR INTESTINE ALLOGRAFT PRIOR $285.28 20050101 99999999 44799 UNLISTED PROCEDURE, INTESTINE $141.75 19990701 99999999 44800 EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY) OR $499.38 20060701 99999999 44820 EXCISION OF LESION OF MESENTERY (SEPARATE PROCEDURE) $478.77 20060701 99999999 44850 SUTURE OF MESENTERY (SEPARATE PROCEDURE) $449.06 20060701 99999999 44900 INCISION AND DRAINAGE OF APPENDICEAL ABSCESS, TRANSABDOMINAL $408.35 20060701 99999999 44901 INCISION AND DRAINAGE OF APPENDICEAL ABSCESS; PERCUTANEOUS $179.24 20060701 99999999 44950 APPENDECTOMY $408.32 20060701 99999999 44955 APPENDECTOMY $81.19 20060701 99999999 44960 APPENDECTOMY $500.95 20060701 99999999 44970 LAPAROSCOPY, SURGICAL, APPENDECTOMY $399.90 20060701 99999999 45000 TRANSRECTAL DRAINAGE OF PELVIC ABSCESS $208.94 20060701 99999999 45005 INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM $102.04 20060701 99999999 45020 INCISION AND DRAINAGE OF DEEP SUPRALEVATOR, PELVIRECTAL, OR $232.49 20060701 99999999 45100 BIOPSY OF ANORECTAL WALL, ANAL APPROACH $208.84 20060701 99999999 45108 ANORECTAL MYOMECTOMY $270.78 20060701 99999999 45110 PROCTECTOMY $1,146.31 20060701 99999999 45111 PROCTECTOMY $809.82 20060701 99999999 45112 PROCTECTOMY, COMBINED ABDOMINOPERINEAL, PULL-THROUGH $1,207.43 20060701 99999999 45113 PROCTECTOMY, PARTIAL, WITH RECTAL MUCOSECTOMY, ILEOANAL ANASTOMOSIS, CREATION OF $1,194.29 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 174
PROC-CODE DESC MAC BEG END 45114 PROCTECTOMY, PARTIAL, WITH ANASTOMOSIS $1,100.42 20060701 99999999 45116 PROCTECTOMY, PARTIAL, WITH ANASTOMOSIS $938.33 20060701 99999999 45119 PROCTECTOMY, COMBINED ABDOMINOPERINEAL PULL-THROUGH PROCEDURE (EG, COLO-ANAL ANA $1,211.32 20060701 99999999 45120 PROCTECTOMY, COMPLETE $1,161.24 20060701 99999999 45121 PROCTECTOMY CMPLT W/SUBTOTAL/TOTAL COLECTOMY W/MULT BIOPS $1,163.20 20060701 99999999 45123 PROCTECTOMY, PARTIAL, WITHOUT ANASTOMOSIS, PERINEAL APPROACH $720.29 20060701 99999999 45126 PELVIC EXENTERATION FOR COLORECTAL MALIGNANCY, WITH PROCTECTOMY (WITH OR WITHOUT $1,595.54 20060701 99999999 45130 EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS $661.22 20060701 99999999 45135 EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS $869.88 20060701 99999999 45136 EXCISION OF ILEOANAL RESERVOIR WITH ILEOSTOMY $1,127.88 20060701 99999999 45150 DIVISION OF STRICTURE OF RECTUM $305.78 20060701 99999999 45160 EXCISION OF RECTAL TUMOR BY PROCTOTOMY, TRANSACRAL OR $601.34 20060701 99999999 45170 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH $440.73 20060701 99999999 45190 DESTRUCTION OF RECTAL TUMOR, ANY METHOD (EG, ELECTRODESICCATION) TRANSANAL APPRO $396.20 20060701 99999999 45300 PROCTOSIGMOIDOSCOPY $24.58 20060701 99999999 45303 PROCTOSIGMOIDOSCOPY $28.68 20060701 99999999 45305 PROCTOSIGMOIDOSCOPY $42.18 20060701 99999999 45307 PROCTOSIGMOIDOSCOPY $56.36 20060701 99999999 45308 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION $49.75 20060701 99999999 45309 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION $78.87 20060701 99999999 45315 PROCTOSIGMOIDOSCOPY $80.98 20060701 99999999 45317 PROCTOSIGMOIDOSCOPY $85.81 20060701 99999999 45320 PROCTO FOR ABLATION OF TUMOR $90.73 20060701 99999999 45321 PROCTOSIGMOIDOSCOPY $68.52 20060701 99999999 45327 PROCTOSIGMOIDOSCOPY, RIGID; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDI $71.12 20060701 99999999 45330 SIGMOIDOSCOPY, FLEXIBLE FIBEROPTIC $41.36 20060701 99999999 45331 SIGMOIDOSCOPY, FLEXIBLE FIBEROPTIC $65.59 20060701 99999999 45332 SIGMOIDOSCOPY, FLEXIBLE FIBEROPTIC $95.63 20060701 99999999 45333 SIGMOIDOSCOPY, FLEXIBLE FIBEROPTIC $99.55 20060701 99999999 45334 SIGMOIDOSCOPY, FLEXIBLE FIBEROPTIC $145.76 20060701 99999999 45335 SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE $56.81 20060701 99999999 45337 SIGMOIDOSCOPY FLEX FIBEROPTIC FOR DECOMPRESSION OF VOLVULUS $123.44 20060701 99999999 45338 SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) $124.22 20060701 99999999 45339 SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) $160.19 20060701 99999999 45340 SIGMOIDOSCOPY, FLEXIBLE; WITH DILATION BY BALLOON, 1 OR MORE STRICTURES $68.00 20060701 99999999 45341 SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION $112.92 20060701 99999999 45342 SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TR $164.69 20060701 99999999 45345 SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDILAT $121.32 20060701 99999999 45355 COLONOSCOPY, WITH STANDARD SIGMOIDOSCOPE, TRANSABDOMINAL VIA $138.95 20060701 99999999 45378 COLONOSCOPY, FIBEROPTIC, BEYOND SPLENIC FLEXURE $193.08 20060701 99999999 45379 COLONOSCOPY, FIBEROPTIC, BEYOND SPLENIC FLEXURE $246.25 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 175
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