Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 47711 EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT; EXTRAH $916.27 20060701 99999999 47712 EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT; INTRAH $1,130.34 20060701 99999999 47715 EXCISION OF CHOLEDOCHAL CYST $733.42 20060701 99999999 47716 ANASTOMOSIS CHOLEDOCHAL CYST W/O EXCISION $625.46 19990701 99999999 47719 ANASTOMOSIS, CHOLEDOCHAL CYST, WITHOUT EXCISION $733.90 20070101 99999999 47720 CHOLECYSTOENTEROSTOMY $663.65 20060701 99999999 47721 CHOLECYSTOENTEROSTOMY $796.79 20060701 99999999 47740 CHOLECYSTOENTEROSTOMY $757.07 20060701 99999999 47741 CHOLECYSTOENTEROSTOMY; ROUX-EN-Y WITH GASTROENTEROSTOMY $911.83 20060701 99999999 47760 ANASTOMOSIS, DIRECT, OF EXTRAHEPATIC BILIARY DUCTS AND $992.35 20060701 99999999 47765 ANASTOMOSIS, DIRECT, OF INTRAHEPATIC DUCTS AND GASTROINTESTINAL TRACT $1,036.82 20060701 99999999 47780 ANASTOMOSIS, ROUX-EN-Y, OF EXTRAHEPATIC BILIARY DUCTS AND $1,037.14 20060701 99999999 ANASTOMOSIS, ROUX-EN-Y, OF INTRAHEPATIC BILIARY DUCTS AND 47785 GASTROINTESTINAL TRACT $1,182.23 20060701 99999999 47800 RECONSTRUCTION, PLASTIC, OF EXTRAHEPATIC BILIARY DUCTS WITH $945.73 20060701 99999999 47801 PLACEMENT OF CHOLEDOCHAL STENT $575.11 20060701 99999999 47802 U-TUBE HEPATICOENTEROSTOMY $858.76 20060701 99999999 47900 SUTURE OF EXTRAHEPATIC BILIARY DUCT FOR PRE-EXISTING INJURY (SEPARATE PROCEDURE) $851.28 20060701 99999999 48000 DRAINAGE OF ABDOMEN FOR PANCREATITIS $994.69 20060701 99999999 48001 PLACEMENT OF DRAINS, PERIPANCREATIC, FOR ACUTE PANCREATITIS; WITH CHOLECYSTOSTOM $1,245.25 20060701 99999999 48005 RESECTION OR DEBRIDEMENT OF PANCREAS AND PERIPANCREATIC TISSUE FOR ACUTE NECROTI $963.94 19990701 99999999 48020 REMOVAL OF PANCREATIC CALCULUS $621.50 20060701 99999999 48100 BIOPSY OF PANCREAS (SEPARATE PROCEDURE) $491.44 20060701 99999999 48102 BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE $199.01 20060701 99999999 48105 RESECTION OR DEBRIDEMENT OF PANCREAS AND PERIPANCREATIC TISSUE FOR ACUTE NECROTI $1,776.88 20070101 99999999 48120 EXCISION OF LESION OF PANCREAS (EG, CYST, ADENOMA) $688.88 20060701 99999999 48140 PANCREATECTOMY, DISTAL SUBTOTAL, WITH OR WITHOUT SPLENECTOMY $981.85 20060701 99999999 48145 PANCREATECTOMY, DISTAL SUBTOTAL, WITH OR WITHOUT SPLENECTOMY $1,057.80 20060701 99999999 48146 PANCREATECTOMY, DISTAL, NEAR-TOTAL WITH PRESERVATION OF DUODENUM (CHILD-TYPE PRO $1,165.69 20060701 99999999 48148 EXCISION OF AMPULLA OF VATER, SIMPLE $728.35 20060701 99999999 48150 PANCREATECTOMY, PROXIMAL SUBTOTAL, WITH PANCREATICODUODENECTOMY $1,960.11 20060701 99999999 48152 PANCREATECTOMY, PROXIMAL SUBTOTAL WITH TOTAL DUODENECTOMY, PARTIAL GASTRECTOMY, $1,828.96 20060701 99999999 48153 PANCREATECTOMY, PROXIMAL SUBTOTAL WITH NEAR-TOTAL DUODENECTOMY, CHOLEDOCHOENTERO $1,958.85 20060701 99999999 48154 PANCREATECTOMY, PROXIMAL SUBTOTAL WITH NEAR-TOTAL DUODENECTOMY, CHOLEDOCHOENTERO $1,831.87 20060701 99999999 48155 PANCREATECTOMY, TOTAL $1,192.36 20060701 99999999 48180 PANCREATICOJEJUNOSTOMY, SIDE-TO-SIDE ANASTOMOSIS, PUESTOW TYPE $1,022.56 19990701 99999999 48400 INJECTION PROCEDURE FOR INTRAOPERATIVE PANCREATOGRAPHY $80.64 20060701 99999999 48500 MARSUPIALIZATION OF CYST OF PANCREAS $642.05 20060701 99999999 48510 EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS $596.13 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 180
PROC-CODE DESC MAC BEG END 48511 EXTERNAL DRAINAGE, PSEUDOCYST OF PANCREAS; PERCUTANEOUS $210.36 20060701 99999999 48520 INTERNAL ANASTOMOSIS OF PANCREATIC CYST TO GASTROINTESTINAL TRACT $704.33 20060701 99999999 48540 INTERNAL ANASTOMOSIS OF PANCREATIC CYST TO GASTROINTESTINAL TRACT $858.82 20060701 99999999 48545 PANCREATORRHAPHY FOR TRAUMA $737.98 20060701 99999999 48547 DUODENAL EXCLUSION WITH GASTROJEJUNOSTOMY FOR PANCREATIC TRAUMA $1,026.40 20060701 99999999 48548 PANCREATICOJEJUNOSTOMY, SIDE-TO-SIDE ANASTOMOSIS (PUESTOW-TYPE OPERATION) $1,036.92 20070101 99999999 48552 BACKBENCH RECONSTRUCTION OF CADAVER DONOR PANCREAS ALLOGRAFT PRIOR TO $168.75 20050101 99999999 48554 TRANSPLANTATION OF PANCREATIC ALLOGRAFT $1,489.62 19990701 99999999 48556 REMOVAL OF TRANSPLANTED PANCREATIC ALLOGRAFT $705.83 19990701 99999999 48999 UNLISTED PROCEDURE, PANCREAS $400.67 19990701 99999999 49000 EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR WITHOUT $547.40 20060701 99999999 49002 REOPENING OF RECENT LAPAROTOMY INCISION FOR EXPLORATION, $498.36 20060701 99999999 49010 EXPLORATION, RETROPERITONEAL AREA WITH OR WITHOUT BIOPSY(S) $581.10 20060701 99999999 49020 DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, $830.85 20060701 99999999 49021 DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF APPENDICEA $178.63 20060701 99999999 49040 DRAINAGE OF SUBDIAPHRAGMATIC OR SUBPHRENIC ABSCESS $501.68 20060701 99999999 49041 DRAINAGE OF SUBDIAPHRAGMATIC OR SUBPHRENIC ABSCESS; PERCUTANEOUS $210.66 20060701 99999999 49060 DRAINAGE OF RETROPERITONEAL ABSCESS $581.59 20060701 99999999 49061 DRAINAGE OF RETROPERITONEAL ABSCESS; PERCUTANEOUS $194.96 20060701 99999999 49062 DRAINAGE OF EXTRAPERITONEAL LYMPHOCELE TO PERITONEAL CAVITY, OPEN $570.28 20060701 99999999 49080 PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE $58.74 20060701 99999999 49081 PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE $54.19 20060701 99999999 49085 REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY $398.85 19990701 99999999 49180 BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS, PERCUTANEOUS $85.89 20060701 99999999 49200 EXCISION OR DESTRUCTION BY ANY METHOD OF INTRA-ABDOMINAL OR $527.64 19990701 99999999 49201 EXCISION OR DESTRUCTION BY ANY METHOD OF INTRA-ABDOMINAL OR $756.00 19990701 99999999 49203 EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1 $571.70 20080101 99999999 49204 EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1 $717.21 20080101 99999999 49205 EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1 $831.10 20080101 99999999 49215 EXCISION OF PRESACRAL OR SACROCOCCYGEAL TUMOR $1,199.60 20060701 99999999 49220 STAGING CELIOTOMY (LAPAROTOMY) FOR HODGKIN'S DISEASE OR $756.34 20060701 99999999 49250 UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE $395.48 20060701 99999999 49255 OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM (SEPARATE $504.80 20060701 99999999 49320 LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; DIAGNOSTIC, WITH OR WIT $266.69 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 181
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