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Medicaid Fee Schedule without Mods 200801

Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END<br />

61026 VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, $111.31 20060701 99999999<br />

61050 CISTERNAL OR LATERAL CERVICAL PUNCTURE $81.80 20060701 99999999<br />

61055 CISTERNAL OR LATERAL CERVICAL PUNCTURE $108.48 20060701 99999999<br />

61070 PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION $78.40 20060701 99999999<br />

61105 TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE $312.39 20060701 99999999<br />

61107 TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE $296.10 20060701 99999999<br />

61108 TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE $617.54 20060701 99999999<br />

61120 BURR HOLE(S) FOR VENTRICULAR PUNCTURE (INCLUDING $466.09 20060701 99999999<br />

61140 BURR HOLE(S) OR TREPHINE $888.21 20060701 99999999<br />

61150 BURR HOLE(S) OR TREPHINE $958.79 20060701 99999999<br />

61151 BURR HOLE(S) OR TREPHINE $554.54 20060701 99999999<br />

61154 BURR HOLE(S) WITH EVACUATION AND/OR DRAINAGE OF HEMATOMA, $896.50 20060701 99999999<br />

61156 BURR HOLE(S) $944.90 20060701 99999999<br />

61210 BURR HOLE(S) $338.18 20060701 99999999<br />

61215 INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR $308.16 20060701 99999999<br />

61250 BURR HOLE(S) OR TREPHINE, SUPRATENTORIAL, EXPLORATORY, $566.02 20060701 99999999<br />

61253 BURR HOLE(S) OR TREPHINE, INFRATENTORIAL, UNILATERAL $663.72 20060701 99999999<br />

61304 CRANIECTOMY OR CRANIOTOMY, EXPLORATORY $1,288.38 20060701 99999999<br />

61305 CRANIECTOMY OR CRANIOTOMY, EXPLORATORY $1,554.65 20060701 99999999<br />

61312 CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, $1,401.33 20060701 99999999<br />

61313<br />

CRANIECTOMY OR CRANIOTOMY EVACUATION OF HEMATOMA<br />

SUPRATENTOR $1,413.68 20060701 99999999<br />

61314<br />

CRANIECTOMY OR OTOMY FOR EVACUATION HEMATOMA<br />

INFRATENTORIAL $1,412.58 20060701 99999999<br />

61315<br />

CRANIECTOMY OR OTOMY EVACUATION HEMATOMA<br />

INFRATENTORIAL $1,528.49 20060701 99999999<br />

61316<br />

INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL BONE<br />

GRAFT (LIST SEPARATELY IN AD $63.17 20060701 99999999<br />

61320 CRANIECTOMY OR CRANIOTOMY, DRAINAGE OF INTRACRANIAL $1,346.46 20060701 99999999<br />

61321 CRANIECTOMY OR CRANIOTOMY, DRAINAGE OF INTRACRANIAL $1,466.71 20060701 99999999<br />

61322<br />

CRANIECTOMY OR CRANIOTOMY, DECOMPRESSIVE, WITH OR<br />

WITHOUT DURAPLASTY, FOR TREATM $1,302.42 20060701 99999999<br />

61323<br />

CRANIECTOMY OR CRANIOTOMY, DECOMPRESSIVE, WITH OR<br />

WITHOUT DURAPLASTY, FOR TREATM $1,347.98 20060701 99999999<br />

61330 DECOMPRESSION OF ORBIT ONLY, TRANSCRANIAL $1,166.58 20060701 99999999<br />

61332 EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH) $1,476.34 20060701 99999999<br />

61333 EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH) $1,426.23 20060701 99999999<br />

61334 EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH) $977.09 20060701 99999999<br />

61340 OTHER CRANIAL DECOMPRESSION (EG, SUBTEMPORAL), $1,010.43 20060701 99999999<br />

61343<br />

CRANIECTOMY SUBOCCIPITAL W/CERVICAL LAMINECTOMY<br />

DECOMPRESSIO $1,714.04 20060701 99999999<br />

61345 OTHER CRANIAL DECOMPRESSION, POSTERIOR FOSSA $1,436.19 20060701 99999999<br />

61440<br />

CRANIOTOMY FOR SECTION OF TENTORIUM CEREBELLI (SEPARATE<br />

PROCEDURE) $1,348.01 20060701 99999999<br />

61450 CRANIECTOMY, SUBTEMPORAL, FOR SECTION, COMPRESSION, OR $1,382.39 20060701 99999999<br />

61458 CRANIECTOMY, SUBOCCIPITAL $1,559.62 20060701 99999999<br />

61460 CRANIECTOMY, SUBOCCIPITAL $1,552.59 20060701 99999999<br />

61470 CRANIECTOMY, SUBOCCIPITAL $1,251.57 20060701 99999999<br />

61480 CRANIECTOMY, SUBOCCIPITAL $1,312.16 20060701 99999999<br />

61490 CRANIOTOMY FOR LOBOTOMY, INCLUDING CINGULOTOMY $1,224.24 20060701 99999999<br />

61500 CRANIECTOMY $1,053.77 20060701 99999999<br />

61501 CRANIECTOMY $871.64 20060701 99999999<br />

61510 CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY $1,603.92 20060701 99999999<br />

61512 CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY $1,900.49 20060701 99999999<br />

61514 CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY $1,450.68 20060701 99999999<br />

61516 CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY $1,447.85 20060701 99999999<br />

Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 205

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