Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 56301 LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION $271.66 19990701 99999999 56302 LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR $281.02 19990701 99999999 56303 LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PEL $498.23 19990701 99999999 56304 LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS $486.29 19990701 99999999 56305 LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE) $270.35 19990701 99999999 56306 LAPAROSCOPY, SURGICAL; WITH ASPIRATION (SINGLE OR MULTIPLE) $278.98 19990701 99999999 56307 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPH $500.08 19990701 99999999 56308 LAPAROSCOPY, SURGICAL; WITH VAGINAL HYSTERECTOMY WITH OR WITHOUT REMOVAL OF TUBE $645.24 19990701 99999999 56309 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA, SUBSEROSAL (SINGLE OR MULTIP $568.81 19990701 99999999 56310 LAPAROSCOPY, SURGICAL; ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PR $642.96 19990701 99999999 56311 LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE $427.71 19990701 99999999 56312 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY $564.62 19990701 99999999 56313 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORT $658.12 19990701 99999999 56314 LAPAROSCOPY, SURGICAL; WITH DRAINAGE OF LYMPHOCELE TO PERITONEAL CAVITY $443.51 19990701 99999999 56315 LAPAROSCOPY, SURGICAL; APPENDECTOMY $385.86 19990701 99999999 56316 LAPAROSCOPY, SURGICAL; REPAIR OF INITIAL INGUINAL HERNIA $294.69 19990701 99999999 56317 LAPAROSCOPY, SURGICAL; REPAIR OF RECURRENT INGUINAL HERNIA $375.82 19990701 99999999 56318 LAPAROSCOPY, SURGICAL; ORCHIECTOMY $494.37 19990701 99999999 56320 LAPAROSCOPY, SURGICAL; WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE $297.30 19990701 99999999 56322 LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, TRUNCAL $439.64 19990701 99999999 56323 LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, SELECTIVE OR HIGHLY SELECTIV $525.34 19990701 99999999 56324 LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY $593.75 19990701 99999999 56340 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY (ANY METHOD) $521.52 19990701 99999999 56341 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY $558.68 19990701 99999999 56342 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT $653.59 19990701 99999999 56343 LAPAROSCOPY, SURGICAL; WITH SALPINGOSTOMY (SALPINGONEOSTOMY) $561.55 19990701 99999999 56344 LAPAROSCOPY, SURGICAL; WITH FIMBRIOPLASTY $531.13 19990701 99999999 56346 LAPAROSCOPY, SURGICAL; GASTROSTOMY, TEMPORARY (TUBE OR RUBBER OR PLASTIC) (SEPAR $373.54 19990701 99999999 56348 LAPAROSCOPY, SURGICAL; INTESTINAL RESECTION, WITH ANASTOMOSIS (INTRA OR EXTRACOR $992.01 19990701 99999999 56349 LAPAROSCOPY, SURGICAL; ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, BELSEY IV, HILL, $802.34 19990701 99999999 56350 HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE) $147.85 19990701 99999999 56351 HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY $196.39 19990701 99999999 56352 HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD) $275.19 19990701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 196
PROC-CODE DESC MAC BEG END 56353 HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTION OF INTRAUTERINE SEPTUM (ANY M $303.52 19990701 99999999 56354 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA $425.72 19990701 99999999 56355 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY $212.05 19990701 99999999 56356 HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (ANY METHOD) $285.80 19990701 99999999 56362 PERITONEOSCOPY WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY; WITHOUT BIOPSY $216.88 19990701 99999999 56363 PERITONEOSCOPY WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY; WITH BIOPSY $246.02 19990701 99999999 56405 INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS $66.23 20060701 99999999 56420 INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS, UNILATERAL $63.97 20060701 99999999 56440 MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST $157.90 20060701 99999999 56441 LYSIS OF LABIAL ADHESIONS $112.80 20060701 99999999 56442 HYMENOTOMY, SIMPLE INCISION $32.99 20070101 99999999 56501 DESTRUCTION OF LESION(S), VULVA $69.56 20060701 99999999 56515 DESTRUCTION OF LESION(S), VULVA $116.35 20060701 99999999 56605 BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); ONE LESION $43.68 20060701 99999999 56606 BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESIO $21.72 20060701 99999999 56620 VULVECTOMY $390.56 20060701 99999999 56625 VULVECTOMY $476.04 20060701 99999999 56630 VULVECTOMY, RADICAL $686.25 20060701 99999999 56631 VULVECTOMY, RADICAL, PARTIAL; WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY $905.72 20060701 99999999 56632 VULVECTOMY, RADICAL, PARTIAL; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY $1,051.68 20060701 99999999 56633 VULVECTOMY, RADICAL, COMPLETE; $868.98 20060701 99999999 56634 VULVECTOMY, RADICAL, COMPLETE; WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY $994.04 20060701 99999999 56637 VULVECTOMY, RADICAL, COMPLETE; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY $1,162.83 20060701 99999999 56640 VULVECTOMY, RADICAL, WITH INGUINOFEMORAL, ILIAC, $1,141.58 20060701 99999999 56700 HYMENECTOMY, PARTIAL EXCISION OF HYMEN $147.23 20060701 99999999 56720 HYMENOTOMY, SIMPLE INCISION $44.04 20030401 99999999 56740 EXCISION OF BARTHOLIN'S GLAND OR CYST $207.14 20060701 99999999 56800 PLASTIC REPAIR OF INTROITUS $199.14 20060701 99999999 56805 CLITOROPLASTY FOR ADRENOGENITAL SYNDROME $857.66 20060701 99999999 56810 PERINEOPLASTY, REPAIR OF PERINEUM, NON-OBSTETRICAL (SEPARATE PROCEDURE) $201.84 20060701 99999999 56820 COLPOSCOPY OF THE VULVA; $61.17 20060701 99999999 56821 COLPOSCOPY OF THE VULVA; WITH BIOPSY (S) $84.39 20060701 99999999 57000 COLPOTOMY $152.28 20060701 99999999 57010 COLPOTOMY $272.07 20060701 99999999 57020 COLPOCENTESIS (SEPARATE PROCEDURE) $61.88 20060701 99999999 57022 INCISION AND DRAINAGE OF VAGINAL HEMATOMA; POST- OBSTETRICAL $134.43 20060701 99999999 57023 INCISION AND DRAINAGE OF VAGINAL HEMATOMA; NON-OBSTETRICAL (EG, POST-TRAUMA, SPO $216.83 20060701 99999999 57061 DESTRUCTION OF VAGINAL LESION(S) $60.98 20060701 99999999 57065 DESTRUCTION OF VAGINAL LESION(S) $155.10 20060701 99999999 57100 BIOPSY OF VAGINAL MUCOSA $42.10 20060701 99999999 57105 BIOPSY OF VAGINAL MUCOSA $84.28 20060701 99999999 57106 VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; $264.24 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 197
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Medicaid Fee Schedule without Mods 200801

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