Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 49321 LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; WITH BIOPSY (SINGLE OR $284.44 20060701 99999999 49322 LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; WITH ASPIRATION OF CAVI $295.14 20060701 99999999 49323 LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; WITH DRAINAGE OF LYMPHO $452.92 20060701 99999999 49324 LAPAROSCOPY, SURGICAL; WITH INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER, PE $248.28 20070101 99999999 49325 LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNUL $266.83 20070101 99999999 49326 LAPAROSCOPY, SURGICAL; WITH OMENTOPEXY (OMENTAL TACKING PROCEDURE) (LIST SEPARAT $120.33 20070101 99999999 49329 UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM $548.58 20000101 99999999 49400 PNEUMOPERITONEUM (SEPARATE PROCEDURE) $80.29 20060701 99999999 49402 REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY $532.43 20070101 99999999 49419 INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER, WITH SUBCUTANEOUS RESERVOIR, P $301.18 20060701 99999999 49420 INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR $103.28 20060701 99999999 49421 INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR $290.20 20060701 99999999 49422 REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER $297.22 20060701 99999999 49423 EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST DRAINAGE CATHETER UNDER RADIOLOGIC $67.13 20060701 99999999 49424 CONTRAST INJECTION FOR ASSESSMENT OF ABSCESS OR CYST VIA PREVIOUSLY PLACED CATHE $34.35 20060701 99999999 49425 PERITONEAL-VENOUS SHUNT (EG, LEVEEN SHUNT) $584.98 20060701 99999999 49426 REVISION OF PERITONEAL-VENOUS SHUNT $461.01 20060701 99999999 49427 INJECTION PROCEDURE (EG, CONTRAST MEDIA) FOR EVALUATION OF PREVIOUSLY PLACED PER $36.89 20060701 99999999 49428 LIGATION OF PERITONEAL-VENOUS SHUNT $252.09 20060701 99999999 49429 REMOVAL OF PERITONEAL-VENOUS SHUNT $329.32 20060701 99999999 49435 INSERTION OF SUBCUTANEOUS EXTENSION TO INTRAPERITONEAL CANNULA OR CATHETER WITH $77.41 20070101 99999999 49436 DELAYED CREATION OF EXIT SITE FROM EMBEDDED SUBCUTANEOUS SEGMENT OF INTRAPERITON $118.49 20070101 99999999 49440 INJ PROC FOR PELVIC PNEUMOGRAPHY $124.56 20080101 99999999 49441 INSERTION OF DUODENOSTOMY OR JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC $139.89 20080101 99999999 49442 INSERTION OF CECOSTOMY OR OTHER COLONIC TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC G $113.42 20080101 99999999 49446 CONVERSION OF GASTROSTOMY TUBE TO GASTRO-JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER F $88.90 20080101 99999999 49450 REPLACEMENT OF GASTROSTOMY OR CECOSTOMY (OR OTHER COLONIC) TUBE, PERCUTANEOUS, U $35.77 20080101 99999999 49451 REPLACEMENT OF DUODENOSTOMY OR JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPI $49.63 20080101 99999999 49452 REPLACEMENT OF GASTRO-JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANC $77.44 20080101 99999999 49460 MECHANICAL REMOVAL OF OBSTRUCTIVE MATERIAL FROM GASTROSTOMY, DUODENOSTOMY, JEJUN $25.33 20080101 99999999 49465 CONTRAST INJECTION(S) FOR RADIOLOGICAL EVALUATION OF EXISTING GASTROSTOMY, DUODE $16.81 20080101 99999999 49491 REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT $476.47 20060701 99999999 49492 REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT $582.93 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 182
PROC-CODE DESC MAC BEG END 49495 REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH OR WITHOUT HYDROCELECTO $310.63 20060701 99999999 49496 REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH OR WITHOUT HYDROCELECTO $444.12 20060701 99999999 49500 REPAIR INGUINAL HERNIA, UNDER AGE 5 YEARS, WITH OR WITHOUT $266.17 20060701 99999999 49501 RPR INQNL HERNIA UNDER AGE 5 W/WO HYDRCLMY;BI $366.73 20060701 99999999 49505 REPAIR INGUINAL HERNIA, AGE 5 OR OVER $320.63 20060701 99999999 49507 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATE $405.91 20060701 99999999 49520 REPAIR INGUINAL HERNIA, ANY AGE $401.86 20060701 99999999 49521 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED $461.07 20060701 99999999 49525 REPAIR INGUINAL HERNIA, ANY AGE $373.73 20060701 99999999 49540 REPAIR LUMBAR HERNIA $425.09 20060701 99999999 49550 REPAIR FEMORAL HERNIA, GROIN INCISION $354.10 20060701 99999999 49553 REPAIR FEMORAL HERNIA;BILATERAL $379.37 20060701 99999999 49555 REPAIR FEMORAL HERNIA, RECURRENT, ANY APPROACH $397.79 20060701 99999999 49557 REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED $454.61 20060701 99999999 49560 REPAIR VENTRAL (INCISIONAL) HERNIA (SEPARATE PROCEDURE) $466.02 20060701 99999999 49561 REPAIR INITIAL INCISIONAL HERNIA; INCARCERATED OR STRANGULATED $539.91 20060701 99999999 49565 REPAIR VENTRAL (INCISIONAL) HERNIA (SEPARATE PROCEDURE) $480.43 20060701 99999999 49566 REPAIR RECURRENT INCISIONAL HERNIA; INCARCERATED OR STRANGULATED $556.99 20060701 99999999 49568 IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR INCISIONAL HERNIA REPAIR (LIST SEPA $213.33 20060701 99999999 49570 REPAIR EPIGASTRIC HERNIA, PROPERITONEAL FAT $264.30 20060701 99999999 49572 REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED $316.24 20060701 99999999 49580 REPAIR UMBILICAL HERNIA $209.11 20060701 99999999 49582 REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; INCARCERATED OR STRANGULATED $310.03 20060701 99999999 49585 REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE $285.21 20060701 99999999 49587 REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED $319.84 20060701 99999999 49590 REPAIR SPIGELIAN HERNIA $374.50 20060701 99999999 49600 REPAIR OF OMPHALOCELE $473.64 20060701 99999999 49605 REPAIR OF OMPHALOCELE $2,626.52 20060701 99999999 49606 REPAIR OF OMPHALOCELE $816.81 20060701 99999999 49610 REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION) $497.88 20060701 99999999 49611 REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION) $498.46 20060701 99999999 49650 LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA $309.04 20060701 99999999 49651 LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA $395.21 20060701 99999999 49900 SUTURE, SECONDARY, OF ABDOMINAL WALL FOR EVISCERATION $520.10 20060701 99999999 49904 OMENTAL FLAP, EXTRA-ABDOMINAL (EG, FOR RECONSTRUCTION OF STERNAL AND CHEST WALL $1,046.04 20060701 99999999 49905 OMENTAL FLAP (EG, FOR RECONSTRUCTION OF STERNAL AND CHEST WALL DEFECTS) (LIST SE $286.03 20060701 99999999 49999 UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM $695.22 19990701 99999999 50010 RENAL EXPLORATION, NOT NECESSITATING OTHER SPECIFIC PROCEDURES $570.01 20060701 99999999 50020 DRAINAGE OF PERIRENAL OR RENAL ABSCESS (SEPARATE PROCEDURE) $692.83 20060701 99999999 50021 DRAINAGE OF PERIRENAL OR RENAL ABSCESS; PERCUTANEOUS $177.90 20060701 99999999 50040 NEPHROSTOMY, NEPHROTOMY WITH DRAINAGE $689.23 20060701 99999999 50045 NEPHROTOMY, WITH EXPLORATION $723.63 20060701 99999999 50060 NEPHROLITHOTOMY $886.97 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 183
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Medicaid Fee Schedule without Mods 200801

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