Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
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PROC-CODE DESC MAC BEG END<br />
61619<br />
SECONDARY REPAIR OF DURA FOR CSF LEAK, ANTERIOR, MIDDLE OR<br />
POSTERIOR CRANIAL FOS $1,070.72 20060701 99999999<br />
61623<br />
ENDOVASCULAR TEMPORARY BALLOON ARTERIAL OCCLUSION, HEAD<br />
OR NECK (EXTRACRANIAL/IN $399.97 20060701 99999999<br />
61624<br />
TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR<br />
DESTRUCTION, TO ACHIEVE H $909.31 20060701 99999999<br />
61626<br />
TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR<br />
DESTRUCTION, TO ACHIEVE H $743.41 20060701 99999999<br />
61680<br />
SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION<br />
SUPRATENTORI $1,769.67 20060701 99999999<br />
61682<br />
SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION<br />
SUPRATENTORI $3,049.05 20060701 99999999<br />
61684<br />
SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION<br />
INFRATENTORI $2,125.53 20060701 99999999<br />
61686<br />
SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION<br />
INFRATENTORI $3,193.88 20060701 99999999<br />
61690<br />
SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION DURAL<br />
SIMPLE $1,635.70 20060701 99999999<br />
61692<br />
SURG INTRACRANIAL ARTERIOVENOUS MALFORMATION DURAL<br />
CMPLX $2,532.51 20060701 99999999<br />
61697<br />
SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL<br />
APPROACH; CAROTID CIRCULA $2,369.46 20060701 99999999<br />
61698<br />
SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL<br />
APPROACH; VERTEBROBASILAR $2,275.15 20060701 99999999<br />
61700 SURGERY OF INTRACRANIAL ANEURYSM, INTRACRANIAL $2,555.11 20060701 99999999<br />
61702 SURGERY OF INTRACRANIAL ANEURYSM, INTRACRANIAL $2,554.42 20060701 99999999<br />
61703 SURGERY OF INTRACRANIAL ANEURYSM, CERVICAL APPROACH $918.22 20060701 99999999<br />
61705 SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR $1,940.02 20060701 99999999<br />
61708 SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR $1,617.98 20060701 99999999<br />
61710 SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR $1,342.23 20060701 99999999<br />
61711 ANASTOMOSIS, ARTERIAL, EXTRACRANIAL-INTRACRANIAL $2,012.93 20060701 99999999<br />
61720<br />
CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR<br />
HOLE(S) $1,002.65 20060701 99999999<br />
61735<br />
CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR<br />
HOLE(S) $1,055.48 20060701 99999999<br />
61750 STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING $967.78 20060701 99999999<br />
61751 STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING $1,046.69 20060701 99999999<br />
61760<br />
STEREOTACTIC IMPLANTATION OF DEPTH ELECTRODES INTO THE<br />
CEREBRUM FOR LONG TERM SE $1,049.67 20060701 99999999<br />
61770<br />
STEREOTACTIC LOCALIZATION ANY METHOD INCL BURR HOLES<br />
W/INSER $1,195.73 20060701 99999999<br />
61790<br />
CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS,<br />
BY $611.03 20060701 99999999<br />
61791<br />
CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS,<br />
BY $765.42 20060701 99999999<br />
61793 STEREOTACTIC FOCUSED PROTON BEAM OR GAMMA RADIOSURGERY $1,025.81 20060701 99999999<br />
61795<br />
STEREOTACTIC COMPUTER ASSIST VOLUMETRIC INTRACRANIAL<br />
PROCEDU $234.94 20060701 99999999<br />
61850 TWIST DRILL OR BURR HOLE(S) FOR IMPLANTATION OF $699.38 20060701 99999999<br />
61855 TWIST DRILL OR BURR HOLE(S) FOR IMPLANTATION OF $675.09 19990701 99999999<br />
61860 CRANIECTOMY OR CRANIOTOMY FOR IMPLANTATION OF $997.32 20060701 99999999<br />
61862<br />
TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY FOR<br />
STEREOTACTIC IMPLANTATION $981.50 20000101 99999999<br />
61863<br />
TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH<br />
STEREOTACTIC IMPLANTATIO $893.47 20060701 99999999<br />
61864<br />
TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH<br />
STEREOTACTIC IMPLANTATIO $258.87 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 208