Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 52327 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC INJECTI $234.22 20060701 99999999 52330 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION) $225.34 20060701 99999999 52332 CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING $146.15 20060701 99999999 52334 CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE $215.51 20060701 99999999 52335 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY $272.56 19990701 99999999 52336 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY $355.17 19990701 99999999 52337 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY $410.93 19990701 99999999 52338 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY $342.45 19990701 99999999 52339 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE $391.45 19990701 99999999 52340 CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF $434.73 19990701 99999999 52341 CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, L $234.26 20060701 99999999 52342 CYSTOURETHROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG, BALLO $253.48 20060701 99999999 52343 CYSTOURETHROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON DILATION $280.74 20060701 99999999 52344 CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, B $415.48 20060701 99999999 52345 CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION ST $319.74 20060701 99999999 52346 CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG $360.04 20060701 99999999 52347 CYSTOURETHROSCOPY WITH TRANSURETHRAL RESECTION OR INCISION OF EJACULATORY DUCTS $207.06 20020101 99999999 52351 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC $303.33 20060701 99999999 52352 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULA $256.17 20060701 99999999 52353 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETER $411.89 20060701 99999999 52354 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGU $273.46 20060701 99999999 52355 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH RESECTION OF TUMOR $328.74 20060701 99999999 52400 CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERI $433.03 20060701 99999999 52402 CYSTOURETHROSCOPY WITH TRANSURETHRAL RESECTION OR INCISION OF EJACULATORY DUCTS $204.53 20060701 99999999 52450 TRANSURETHRAL INCISION OF PROSTATE $387.08 20060701 99999999 52500 TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE) $455.39 20060701 99999999 52510 TRANSURETHRAL BALLOON DILATION OF THE PROSTATIC URETHRA, ANY METHOD $392.69 20030401 99999999 52601 TRANSURETHRAL RESECTION OF PROSTATE, INCLUDING CONTROL OF $659.28 20060701 99999999 52606 TRANSURETHRAL FULGURATION FOR POSTOPERATIVE BLEEDING $369.48 20060701 99999999 52612 TRANSURETHRAL RESECTION OF PROSTATE $462.59 20060701 99999999 52614 TRANSURETHRAL RESECTION OF PROSTATE $395.59 20060701 99999999 52620 TRANSURETHRAL RESECTION $358.47 20060701 99999999 52630 TRANSURETHRAL RESECTION $411.76 20060701 99999999 52640 TRANSURETHRAL RESECTION $371.84 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 190
PROC-CODE DESC MAC BEG END 52647 NON-CONTACT LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BL $554.10 20060701 99999999 52648 CONTACT LASER VAPORIZATION WITH OR WITHOUT TRANSURETHRAL RESECTION OF PROSTATE, $620.08 20060701 99999999 52649 LASER ENUCLEATION OF THE PROSTATE WITH MORCELLATION, INCLUDING CONTROL OF POSTOP $541.97 20080101 99999999 52700 TRANSURETHRAL DRAINAGE OF PROSTATIC ABSCESS $330.54 20060701 99999999 53000 URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE) $127.75 20060701 99999999 53010 URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE) $218.38 20060701 99999999 53020 MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE) $72.72 20060701 99999999 53025 MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE) $51.13 20060701 99999999 53040 DRAINAGE OF DEEP PERIURETHRAL ABSCESS $350.40 20060701 99999999 53060 DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST $118.00 20060701 99999999 53080 DRAINAGE OF PERINEAL URINARY EXTRAVASATION $368.83 20060701 99999999 53085 DRAINAGE OF PERINEAL URINARY EXTRAVASATION $538.45 20060701 99999999 53200 BIOPSY OF URETHRA $104.35 20060701 99999999 53210 URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY $574.43 20060701 99999999 53215 URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY $727.62 20060701 99999999 53220 EXCISION OR FULGURATION OF CARCINOMA OF URETHRA $350.72 20060701 99999999 53230 EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE) $488.48 20060701 99999999 53235 EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE) $458.13 20060701 99999999 53240 MARSUPIALIZATION OF URETHRAL DIVERTICULUM, MALE OR FEMALE $324.96 20060701 99999999 53250 EXCISION OF BULBOURETHRAL GLAND (COWPER'S GLAND) $297.68 20060701 99999999 53260 EXCISION OR FULGURATION $134.32 20060701 99999999 53265 EXCISION OR FULGURATION $150.80 20060701 99999999 53270 EXCISION OR FULGURATION $127.74 20060701 99999999 53275 EXCISION OR FULGURATION $211.80 20060701 99999999 53400 URETHROPLASTY $591.90 20060701 99999999 53405 URETHROPLASTY $695.66 20060701 99999999 53410 URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE ANTERIOR $729.91 20060701 99999999 53415 URETHROPLASTY, TRANSPUBIC OR PERINEAL, ONE STAGE, FOR $877.08 20060701 99999999 53420 URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC $697.18 20060701 99999999 53425 URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC $731.84 20060701 99999999 53430 URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA $705.64 20060701 99999999 53431 URETHROPLASTY WITH TUBULARIZATION OF POSTERIOR URETHRA AND/OR LOWER BLADDER FOR $776.62 20060701 99999999 53440 OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE, WITH OR $684.87 20060701 99999999 53442 REMOVAL OF PERINEAL PROSTHESIS INTRODUCED FOR CONTINENCE $416.54 20060701 99999999 53443 URETHROPLASTY WITH TUBULARIZATION OF POSTERIOR URETHRA AND/OR $868.46 19990701 99999999 53444 INSERTION OF TANDEM CUFF (DUAL CUFF) $560.48 20060701 99999999 53445 OPERATION FOR CORRECTION OF URINARY INCONTINENCE WITH PLACEMENT $774.74 20060701 99999999 53446 REMOVAL OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP, RESERVOIR $526.92 20060701 99999999 53447 REMOVAL, REPAIR OR REPLACEMENT OF INFLATABLE SPHINCTER INCLUDING $633.87 20060701 99999999 53448 REMOVAL AND REPLACEMENT OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING $938.99 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 191
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