Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 50065 NEPHROLITHOTOMY $964.97 20060701 99999999 50070 NEPHROLITHOTOMY $938.50 20060701 99999999 50075 NEPHROLITHOTOMY $1,170.63 20060701 99999999 50080 PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, $764.15 20060701 99999999 50081 PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, $1,044.82 20060701 99999999 50100 TRANSECTION OR REPOSITIONING OF ABERRANT RENAL VESSELS $796.71 20060701 99999999 50120 PYELOTOMY $752.77 20060701 99999999 50125 PYELOTOMY $782.35 20060701 99999999 50130 PYELOTOMY $831.51 20060701 99999999 50135 PYELOTOMY $966.53 20060701 99999999 50200 RENAL BIOPSY $129.47 20060701 99999999 50205 RENAL BIOPSY $511.48 20060701 99999999 50220 NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY APPROACH $841.70 20060701 99999999 50225 NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY APPROACH $994.91 20060701 99999999 50230 NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY APPROACH $1,243.21 20060701 99999999 50234 NEPHRECTOMY WITH TOTAL URETERECTOMY AND BLADDER CUFF $1,066.87 20060701 99999999 50236 NEPHRECTOMY WITH TOTAL URETERECTOMY AND BLADDER CUFF $1,196.92 20060701 99999999 50240 NEPHRECTOMY, PARTIAL $1,074.81 20060701 99999999 50250 ABLATION, OPEN, ONE OR MORE RENAL MASS LESION(S), CRYOSURGICAL, INCLUDING INTRAO $794.68 20060701 99999999 50280 EXCISION OR UNROOFING OF CYST(S) OF KIDNEY $746.78 20060701 99999999 50290 EXCISION OF PERINEPHRIC CYST $686.47 20060701 99999999 50320 DONOR NEPHRECTOMY, WITH PREPARATION AND MAINTENANCE OF $1,071.86 20060701 99999999 50327 BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO $156.77 20060701 99999999 50328 BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO $137.27 20060701 99999999 50329 BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO $131.16 20060701 99999999 50340 RECIPIENT NEPHRECTOMY (SEPARATE PROCEDURE) $702.01 20060701 99999999 50360 RENAL HOMOTRANSPLANTATION, IMPLANTATION OF GRAFT $1,582.57 20060701 99999999 50365 RENAL HOMOTRANSPLANTATION, IMPLANTATION OF GRAFT $1,884.60 20060701 99999999 50370 REMOVAL OF TRANSPLANTED HOMOGRAFT (EG, INFARCTED OR REJECTED $724.90 20060701 99999999 50380 RENAL AUTOTRANSPLANTATION, REIMPLANTATION OF KIDNEY $956.07 20060701 99999999 50382 REMOVAL (VIA SNARE/CAPTURE) AND REPLACEMENT OF INTERNALLY DWELLING URETERAL STEN $199.48 20060701 99999999 50384 REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA PERCUTANEO $181.64 20060701 99999999 50385 REMOVAL (VIA SNARE/CAPTURE) AND REPLACEMENT OF INTERNALLY DWELLING URETERAL STEN $131.59 20080101 99999999 50386 REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA TRANSURETH $99.88 20080101 99999999 50387 REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE TRANSNEPHRIC URETERAL STENT (EG $72.18 20060701 99999999 50389 REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURREN $39.82 20060701 99999999 50390 ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, $90.69 20060701 99999999 50391 INSTILLATION(S) OF THERAPEUTIC AGENT INTO RENAL PELVIS AND/OR URETER THROUGH $75.81 20060701 99999999 50392 INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS $146.77 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 184
PROC-CODE DESC MAC BEG END 50393 INTRODUCTION OF URETERAL CATHETER OR STENT INTO $182.39 20060701 99999999 50394 INJECTION PROCEDURE FOR PYELOGRAPHY (AS NEPHROSTOGRAM, $34.95 20060701 99999999 50395 INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER $163.30 20060701 99999999 50396 MANOMETRIC STUDIES THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR $77.41 20060701 99999999 50398 CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE $55.20 20060701 99999999 50400 PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL $918.87 20060701 99999999 50405 PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL $1,151.74 20060701 99999999 50500 NEPHRORRHAPHY, SUTURE OF KIDNEY WOUND OR INJURY $938.12 20060701 99999999 50520 CLOSURE OF NEPHROCUTANEOUS OR PYELOCUTANEOUS FISTULA $817.28 20060701 99999999 50525 CLOSURE OF NEPHROVISCERAL FISTULA (EG, RENOCOLIC), INCLUDING $1,044.74 20060701 99999999 50526 CLOSURE OF NEPHROVISCERAL FISTULA (EG, RENOCOLIC), INCLUDING $1,029.74 20060701 99999999 50540 SYMPHYSIOTOMY FOR HORSESHOE KIDNEY WITH OR WITHOUT PYELOPLASTY $934.90 20060701 99999999 50541 LAPAROSCOPY, SURGICAL; ABLATION OF RENAL CYSTS $650.50 20060701 99999999 50542 LAPAROSCOPY, SURGICAL; ABLATION OF RENAL MASS LESION(S) $806.44 20060701 99999999 50543 LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY $1,015.39 20060701 99999999 50544 LAPAROSCOPY, SURGICAL; PYELOPLASTY $894.84 20060701 99999999 50545 LAPAROSCOPY, SURGICAL; RADICAL NEPHRECTOMY (INCLUDES REMOVAL OF GEROTA¦S FASCIA $939.60 20060701 99999999 50546 LAPAROSCOPY, SURGICAL; NEPHRECTOMY $830.93 20060701 99999999 50547 LAPAROSCOPY, SURGICAL; DONOR NEPHRECTOMY FROM LIVING DONOR (EXCLUDING PREPARATIO $1,070.27 20060701 99999999 50548 LAPAROSCOPICALLY ASSISTED NEPHROURETERECTOMY $973.94 20060701 99999999 50551 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, $221.80 20060701 99999999 50553 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, $225.77 20060701 99999999 50555 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, $293.87 20060701 99999999 50557 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, $297.92 20060701 99999999 50559 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, $246.11 19990701 99999999 50561 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, $336.24 20060701 99999999 50562 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT I $426.59 20060701 99999999 50570 RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT $339.11 20060701 99999999 50572 RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT $461.96 20060701 99999999 50574 RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT $482.34 20060701 99999999 50575 RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION, INS $629.36 20060701 99999999 50576 RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT $510.44 20060701 99999999 50578 RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT $445.49 19990701 99999999 50580 RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT $452.31 20060701 99999999 50590 LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE $538.30 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 185
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