Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 46762 SPHINCTEROPLASTY ANAL FON INCONT ADULT IMPLANT ARTIFICIAL SP $463.49 20060701 99999999 46900 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, $78.82 20060701 99999999 46910 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, $79.84 20060701 99999999 46916 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, $80.83 20060701 99999999 46917 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, $91.32 20060701 99999999 46922 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, $96.50 20060701 99999999 46924 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, $147.38 20060701 99999999 46934 DESTRUCTION OF HEMORRHOIDS, ANY METHOD $179.26 20060701 99999999 46935 DESTRUCTION OF HEMORRHOIDS, ANY METHOD $96.90 20060701 99999999 46936 DESTRUCTION OF HEMORRHOIDS, ANY METHOD $194.79 20060701 99999999 46937 CRYOSURGERY OF RECTAL TUMOR $140.84 20060701 99999999 46938 CRYOSURGERY OF RECTAL TUMOR $222.99 20060701 99999999 46940 CURETTAGE OR CAUTERIZATION OF ANAL FISSURE, INCLUDING DILATION $84.74 20060701 99999999 46942 CURETTAGE OR CAUTERIZATION OF ANAL FISSURE, INCLUDING DILATION $75.84 20060701 99999999 46945 LIGATION OF INTERNAL HEMORRHOIDS $108.16 20060701 99999999 46946 LIGATION OF INTERNAL HEMORRHOIDS $130.00 20060701 99999999 46947 HEMORRHOIDOPEXY (EG, FOR PROLAPSING INTERNAL HEMORRHOIDS) BY STAPLING $247.07 20060701 99999999 47000 BIOPSY OF LIVER, PERCUTANEOUS NEEDLE $84.69 20060701 99999999 47001 BIOPSY OF LIVER, PERCUTANEOUS NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT TIME OF $89.45 19990701 99999999 47010 HEPATOTOMY FOR DRAINAGE OF ABSCESS OR CYST, ONE OR TWO STAGES $610.61 20060701 99999999 47011 HEPATOTOMY; FOR PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST, ONE OR TWO STAGES $194.96 20060701 99999999 47015 LAPAROTOMY, WITH ASPIRATION AND/OR INJECTION OF HEPATIC PARASITIC (EG, AMOEBIC O $567.60 20060701 99999999 47100 BIOPSY OF LIVER, WEDGE (SEPARATE PROCEDURE) $446.90 20060701 99999999 47120 HEPATECTOMY, RESECTION OF LIVER $1,278.18 20060701 99999999 47122 HEPATECTOMY RESECTION OF LIVER TRISEGEMENTECTOMY $1,931.95 20060701 99999999 47125 HEPATECTOMY, RESECTION OF LIVER $1,733.96 20060701 99999999 47130 HEPATECTOMY, RESECTION OF LIVER $1,874.60 20060701 99999999 47134 DONOR HEPATECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT; PARTIAL, FROM $1,707.93 19990701 99999999 47135 LIVER TRANSPLANT, WITH OR WITHOUT RECIPIENT HEPATECTOMY $3,922.56 20060701 99999999 47136 LIVER ALLOTRANSPLANTATION; HETEROTOPIC, PARTIAL OR WHOLE, FROM CADAVER OR LIVING $3,158.55 20060701 99999999 47140 DONOR HEPATECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT, FROM LIVING DO $2,268.96 20060701 99999999 47141 DONOR HEPATECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT, FROM LIVING DO $2,744.96 20060701 99999999 47142 DONOR HEPATECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT, FROM LIVING DO $2,873.06 20060701 99999999 47146 BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR LIVER GRAFT PRIOR TO $244.53 20050101 99999999 47147 BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR LIVER GRAFT PRIOR TO $285.28 20050101 99999999 47300 MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER $563.07 20060701 99999999 47350 HEPATORRHAPHY, SUTURE OF LIVER WOUND OR INJURY $717.82 20060701 99999999 47360 HEPATORRHAPHY, SUTURE OF LIVER WOUND OR INJURY $968.62 20060701 99999999 47361 MANAGEMENT OF LIVER HEMORRHAGE; EXPLORATION OF HEPATIC WOUND, EXTENSIVE DEBRIDEM $1,650.49 20060701 99999999 47362 MANAGEMENT OF LIVER HEMORRHAGE; RE-EXPLORATION OF HEPATIC WOUND FOR REMOVAL OF P $688.58 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 178
PROC-CODE DESC MAC BEG END 47370 LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY $701.55 20060701 99999999 47371 LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL $702.71 20060701 99999999 47380 ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY $819.09 20060701 99999999 47381 ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL $825.52 20060701 99999999 47382 ABLATION, ONE OR MORE LIVER TUMOR(S), PERCUTANEOUS, RADIOFREQUENCY $517.98 20060701 99999999 47400 HEPATICOTOMY OR HEPATICOSTOMY WITH EXPLORATION, DRAINAGE, OR $1,137.46 20060701 99999999 47420 CHOLEDOCHOTOMY OR CHOLEDOCHOSTOMY WITH EXPLORATION, DRAINAGE, $774.41 20060701 99999999 47425 CHOLEDOCHOTOMY OR CHOLEDOCHOSTOMY WITH EXPLORATION, DRAINAGE, $812.28 20060701 99999999 47460 TRANSDUODENAL SPHINCTEROTOMY OR SPHINCTEROPLASTY $816.57 20060701 99999999 47480 CHOLECYSTOTOMY OR CHOLECYSTOSTOMY WITH EXPLORATION, DRAINAGE, $485.40 20060701 99999999 47490 PERCUTANEOUS CHOLECYSTOSTOMY $356.49 20060701 99999999 47500 INJECTION PROCEDURE FOR PERCUTANEOUS TRANSHEPATIC $87.57 20060701 99999999 47505 INJECTION PROCEDURE FOR CHOLANGIOGRAPHY THROUGH AN EXISTING CATHETER (EG, PERCUT $38.21 20060701 99999999 47510 INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC CATHETER $407.09 20060701 99999999 47511 INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC STENT FOR INTERNAL AND EXTERNAL BILIAR $495.50 20060701 99999999 47525 CHANGE OF PERCUTANEOUS BILIARY DRAINAGE CATHETER $220.15 20060701 99999999 47530 REVISION AND/OR REINSERTION OF TRANSHEPATIC T-TUBE $250.14 20060701 99999999 47550 BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY) $131.28 20060701 99999999 47552 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT $225.50 20060701 99999999 47553 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT $266.10 20060701 99999999 47554 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT $372.36 20060701 99999999 47555 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT $283.72 20060701 99999999 47556 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; FOR DILATION OF BILIA $314.28 20060701 99999999 47560 LAPAROSCOPY, SURGICAL; WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY, WITHOUT BIOPSY $217.56 20060701 99999999 47561 LAPAROSCOPY, SURGICAL; WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY WITH BIOPSY $246.65 20060701 99999999 47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY $643.90 20060701 99999999 47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY $688.39 20060701 99999999 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT $679.84 20060701 99999999 47570 LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY $612.40 20060701 99999999 47600 CHOLECYSTECTOMY $552.72 20060701 99999999 47605 CHOLECYSTECTOMY $744.14 20060701 99999999 47610 CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT $738.19 20060701 99999999 47612 CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT $817.80 20060701 99999999 47620 CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT $823.01 20060701 99999999 47630 BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS VIA T-TUBE TRACT, $356.28 20060701 99999999 47700 EXPLORATION FOR CONGENITAL ATRESIA OF BILE DUCTS, WITHOUT $684.85 20060701 99999999 47701 PORTOENTEROSTOMY (EG. KASAI PROCEDURE) $1,148.75 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 179
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