Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 50592 ABLATION, ONE OR MORE RENAL TUMOR(S), PERCUTANEOUS, UNILATERAL, RADIOFREQUENCY $264.93 20060701 99999999 50593 ABLATION, RENAL TUMOR(S), UNILATERAL, PERCUTANEOUS, CRYOTHERAPY $252.36 20080101 99999999 50600 URETEROTOMY WITH EXPLORATION OR DRAINAGE (SEPARATE PROCEDURE) $731.97 20060701 99999999 50605 URETEROTOMY FOR INSERTION OF INDWELLING STENT, ALL TYPES $664.87 20060701 99999999 50610 URETEROLITHOTOMY $773.06 20060701 99999999 50620 URETEROLITHOTOMY $737.40 20060701 99999999 50630 URETEROLITHOTOMY $750.51 20060701 99999999 50650 URETERECTOMY, WITH BLADDER CUFF (SEPARATE PROCEDURE) $828.06 20060701 99999999 50660 URETERECTOMY, TOTAL, ECTOPIC URETER, COMBINATION ABDOMINAL, $908.47 20060701 99999999 50684 INJECTION PROCEDURE FOR URETEROGRAPHY OR URETEROPYELOGRAPHY $33.16 20060701 99999999 50686 MANOMETRIC STUDIES THROUGH URETEROSTOMY OR INDWELLING URETERAL $57.27 20060701 99999999 50688 CHANGE OF URETEROSTOMY TUBE $60.73 20060701 99999999 50690 INJECTION PROCEDURE FOR VISUALIZATION OF ILIAL CONDUIT AND/OR $45.97 20060701 99999999 50700 URETEROPLASTY, PLASTIC OPERATION ON URETER (EG, STRICTURE) $765.29 20060701 99999999 50715 URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER FOR $889.96 20060701 99999999 50722 URETEROLYSIS FOR OVARIAN VEIN SYNDROME $771.44 20060701 99999999 50725 URETEROLYSIS FOR RETROCAVAL URETER, WITH REANASTOMOSIS OF $873.50 20060701 99999999 50727 REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE UROSTOMY); $410.72 20060701 99999999 50728 REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE UROSTOMY); WITH REPAIR OF FA $591.11 20060701 99999999 50740 URETEROPYELOSTOMY, ANASTOMOSIS OF URETER AND RENAL PELVIS $883.84 20060701 99999999 50750 URETEROCALYCOSTOMY, ANASTOMOSIS OF URETER TO RENAL CALYX $930.60 20060701 99999999 50760 URETEROURETEROSTOMY $887.21 20060701 99999999 50770 TRANSURETEROURETEROSTOMY, ANASTOMOSIS OF URETER TO $949.89 20060701 99999999 50780 URETERONEOCYSTOSTOMY, ANASTOMOSIS OF URETER TO BLADDER, $889.13 20060701 99999999 50782 URETERONEOCYSTOSTOMY; ANASTOMOSIS OF DUPLICATED URETER TO BLADDER $935.10 20060701 99999999 50783 URETERONEOCYSTOSTOMY; WITH EXTENSIVE URETERAL TAILORING $965.55 20060701 99999999 50785 URETERONEOCYSTOSTOMY, WITH BLADDER FLAP $989.20 20060701 99999999 50800 URETEROENTEROSTOMY, DIRECT ANASTOMOSIS OF URETER TO INTESTINE $792.79 20060701 99999999 50810 URETEROSIGMOIDOSTOMY, WITH CREATION OF SIGMOID BLADDER $974.91 20060701 99999999 50815 URETEROCOLON CONDUIT, INCLUDING BOWEL ANASTOMOSIS $1,059.57 20060701 99999999 50820 URETEROILEAL CONDUIT (ILEAL BLADDER), INCLUDING BOWEL $1,110.05 20060701 99999999 50825 CONTINENT DIVERSION INCL BOWEL ANASTOMOSIS $1,518.52 20060701 99999999 50830 URINARY UNDIVERSION $1,458.64 20060701 99999999 50840 REPLACEMENT OF ALL OR PART OF URETER BY BOWEL SEGMENT, INCLUDING $953.06 20060701 99999999 50845 CUTANEOUS APPENDICO-VESICOSTOMY $962.69 20060701 99999999 50860 URETEROSTOMY, TRANSPLANTATION OF URETER TO SKIN $743.24 20060701 99999999 50900 URETERORRHAPHY, SUTURE OF URETER (SEPARATE PROCEDURE) $667.14 20060701 99999999 50920 CLOSURE OF URETEROCUTANEOUS FISTULA $686.08 20060701 99999999 50930 CLOSURE OF URETEROVISCERAL FISTULA (INCLUDING VISCERAL REPAIR) $878.92 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 186
PROC-CODE DESC MAC BEG END 50940 DELIGATION OF URETER $708.45 20060701 99999999 50945 LAPAROSCOPY, SURGICAL, URETEROLITHOTOMY $687.48 20060701 99999999 50947 LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITH CYSTOSCOPY AND URETERAL STENT P $1,023.82 20060701 99999999 50948 LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITHOUT CYSTOSCOPY AND URETERAL STEN $935.27 20060701 99999999 50951 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR $221.14 20060701 99999999 50953 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR $234.04 20060701 99999999 50955 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR $263.92 20060701 99999999 50957 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR $266.16 20060701 99999999 50959 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR $200.94 19990701 99999999 50961 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR $242.63 20060701 99999999 50970 URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, $323.84 20060701 99999999 50972 URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, $253.39 20060701 99999999 50974 URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, $420.98 20060701 99999999 50976 URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, $407.22 20060701 99999999 50978 URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, $241.96 19990701 99999999 50980 URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, $278.03 20060701 99999999 51000 ASPIRATION OF BLADDER BY NEEDLE $33.63 20030401 99999999 51005 ASPIRATION OF BLADDER $42.26 20030401 99999999 51010 ASPIRATION OF BLADDER $141.75 20030401 99999999 51020 CYSTOTOMY OR CYSTOSTOMY $380.45 20060701 99999999 51030 CYSTOTOMY OR CYSTOSTOMY $345.97 20060701 99999999 51040 CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE $293.18 20060701 99999999 51045 CYSTOTOMY, WITH INSERTION OF URETERAL CATHETER OR STENT (SEPARATE $352.97 20060701 99999999 51050 CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT $430.94 20060701 99999999 51060 TRANSVESICAL URETEROLITHOTOMY $498.15 20060701 99999999 51065 CYSTOTOMY, WITH STONE BASKET EXTRACTION AND/OR ULTRASONIC OR $452.68 20060701 99999999 51080 DRAINAGE OF PERIVESICAL OR PREVESICAL SPACE ABSCESS $329.90 20060701 99999999 51100 ASPIRATION OF BLADDER; BY NEEDLE $21.13 20080101 99999999 51101 ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER $27.79 20080101 99999999 51102 ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER $136.10 20080101 99999999 51500 EXCISION OF URACHAL CYST OR SINUS, WITH OR WITHOUT UMBILICAL $494.78 20060701 99999999 51520 CYSTOTOMY $492.96 20060701 99999999 51525 CYSTOTOMY $684.56 20060701 99999999 51530 CYSTOTOMY $612.79 20060701 99999999 51535 CYSTOTOMY FOR EXCISION, INCISION, OR REPAIR OF URETEROCELE $594.46 20060701 99999999 51550 CYSTECTOMY, PARTIAL $746.85 20060701 99999999 51555 CYSTECTOMY, PARTIAL $960.93 20060701 99999999 51565 CYSTECTOMY, PARTIAL, WITH REIMPLANTATION OF URETER(S) INTO $1,037.68 20060701 99999999 51570 CYSTECTOMY, COMPLETE $1,121.73 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 187
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