Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 61619 SECONDARY REPAIR OF DURA FOR CSF LEAK, ANTERIOR, MIDDLE OR POSTERIOR CRANIAL FOS $1,070.72 20060701 99999999 61623 ENDOVASCULAR TEMPORARY BALLOON ARTERIAL OCCLUSION, HEAD OR NECK (EXTRACRANIAL/IN $399.97 20060701 99999999 61624 TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE H $909.31 20060701 99999999 61626 TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE H $743.41 20060701 99999999 61680 SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION SUPRATENTORI $1,769.67 20060701 99999999 61682 SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION SUPRATENTORI $3,049.05 20060701 99999999 61684 SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION INFRATENTORI $2,125.53 20060701 99999999 61686 SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION INFRATENTORI $3,193.88 20060701 99999999 61690 SURGERY INTRACRANIAL ARTERIOVENOUS MALFORMATION DURAL SIMPLE $1,635.70 20060701 99999999 61692 SURG INTRACRANIAL ARTERIOVENOUS MALFORMATION DURAL CMPLX $2,532.51 20060701 99999999 61697 SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; CAROTID CIRCULA $2,369.46 20060701 99999999 61698 SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; VERTEBROBASILAR $2,275.15 20060701 99999999 61700 SURGERY OF INTRACRANIAL ANEURYSM, INTRACRANIAL $2,555.11 20060701 99999999 61702 SURGERY OF INTRACRANIAL ANEURYSM, INTRACRANIAL $2,554.42 20060701 99999999 61703 SURGERY OF INTRACRANIAL ANEURYSM, CERVICAL APPROACH $918.22 20060701 99999999 61705 SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR $1,940.02 20060701 99999999 61708 SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR $1,617.98 20060701 99999999 61710 SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR $1,342.23 20060701 99999999 61711 ANASTOMOSIS, ARTERIAL, EXTRACRANIAL-INTRACRANIAL $2,012.93 20060701 99999999 61720 CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR HOLE(S) $1,002.65 20060701 99999999 61735 CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR HOLE(S) $1,055.48 20060701 99999999 61750 STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING $967.78 20060701 99999999 61751 STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING $1,046.69 20060701 99999999 61760 STEREOTACTIC IMPLANTATION OF DEPTH ELECTRODES INTO THE CEREBRUM FOR LONG TERM SE $1,049.67 20060701 99999999 61770 STEREOTACTIC LOCALIZATION ANY METHOD INCL BURR HOLES W/INSER $1,195.73 20060701 99999999 61790 CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY $611.03 20060701 99999999 61791 CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY $765.42 20060701 99999999 61793 STEREOTACTIC FOCUSED PROTON BEAM OR GAMMA RADIOSURGERY $1,025.81 20060701 99999999 61795 STEREOTACTIC COMPUTER ASSIST VOLUMETRIC INTRACRANIAL PROCEDU $234.94 20060701 99999999 61850 TWIST DRILL OR BURR HOLE(S) FOR IMPLANTATION OF $699.38 20060701 99999999 61855 TWIST DRILL OR BURR HOLE(S) FOR IMPLANTATION OF $675.09 19990701 99999999 61860 CRANIECTOMY OR CRANIOTOMY FOR IMPLANTATION OF $997.32 20060701 99999999 61862 TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY FOR STEREOTACTIC IMPLANTATION $981.50 20000101 99999999 61863 TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC IMPLANTATIO $893.47 20060701 99999999 61864 TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC IMPLANTATIO $258.87 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 208
PROC-CODE DESC MAC BEG END 61865 CRANIECTOMY OR CRANIOTOMY FOR IMPLANTATION OF $1,126.99 19990701 99999999 61867 TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC IMPLANTATIO $1,363.66 20060701 99999999 61868 TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC IMPLANTATIO $380.73 20060701 99999999 61870 CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR $676.02 20060701 99999999 61875 CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR $722.72 20060701 99999999 61880 REVISION OR REMOVAL OF INTRACRANIAL NEUROSTIMULATOR ELECTRODES $358.15 20060701 99999999 61885 INCISION FOR SUBCUTANEOUS PLACEMENT OF NEUROSTIMULATOR $336.51 20060701 99999999 61886 INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR O $432.93 20060701 99999999 61888 REVISION OR REMOVAL OF INTRACRANIAL NEUROSTIMULATOR RECEIVER $257.28 20060701 99999999 62000 ELEVATION OF DEPRESSED SKULL FRACTURE $534.41 20060701 99999999 62005 ELEVATION OF DEPRESSED SKULL FRACTURE $814.15 20060701 99999999 62010 ELEVATION OF DEPRESSED SKULL FRACTURE $1,124.32 20060701 99999999 62100 CRANIOTOMY FOR REPAIR OF DURAL/CSF LEAK, INCLUDING SURGERY FOR $1,260.09 20060701 99999999 62115 REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); NOT REQUIRING BONE $1,071.55 20060701 99999999 62116 REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); WITH CRANIOPLASTY $1,224.54 20060701 99999999 62117 REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); REQUIRING CRANIOTO $1,404.89 20060701 99999999 62120 REPAIR OF ENCEPHALOCELE, INCLUDING CRANIOPLASTY $1,210.60 20060701 99999999 62121 CRANIOTOMY WITH REPAIR OF ENCEPHALOCELE, SKULL BASE $1,164.92 20060701 99999999 62140 CRANIOPLASTY FOR SKULL DEFECT $783.76 20060701 99999999 62141 CRANIOPLASTY FOR SKULL DEFECT $892.74 20060701 99999999 62142 REMOVAL OF BONE FLAP OR PROSTHETIC PLATE OF SKULL $651.28 20060701 99999999 62143 REPLACEMENT OF BONE FLAP OR PROSTHETIC PLATE OF SKULL $697.98 20060701 99999999 62145 CRANIOPLASTY FOR SKULL DEFECT WITH REPARATIVE BRAIN SURGERY $995.12 20060701 99999999 62146 CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONE GRAFTS); UP TO 5 CM DIAMETE $843.96 20060701 99999999 62147 CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONE GRAFTS); LARGER THAN 5 CM D $996.16 20060701 99999999 62148 INCISION AND RETRIEVAL OF SUBCUTANEOUS CRANIAL BONE GRAFT FOR CRANIOPLASTY (LIST $86.72 20060701 99999999 62160 NEUROENDOSCOPY, INTRACRANIAL, FOR PLACEMENT OR REPLACEMENT OF VENTRICULAR CATHET $125.24 20060701 99999999 62161 NEUROENDOSCOPY, INTRACRANIAL; WITH DISSECTION OF ADHESIONS, FENESTRATION OF SEPT $898.92 20060701 99999999 62162 NEUROENDOSCOPY, INTRACRANIAL; WITH FENESTRATION OR EXCISION OF COLLOID CYST, INC $1,148.17 20060701 99999999 62163 NEUROENDOSCOPY, INTRACRANIAL; WITH RETRIEVAL OF FOREIGN BODY $728.29 20060701 99999999 62164 NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF BRAIN TUMOR, INCLUDING PLACEMENT $1,244.20 20060701 99999999 62165 NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF PITUITARY TUMOR, TRANSNASAL OR TR $979.06 20060701 99999999 62180 VENTRICULOCISTERNOSTOMY (TORKILDSEN TYPE OPERATION) $1,101.56 20060701 99999999 62190 CREATION OF SHUNT $665.86 20060701 99999999 62192 CREATION OF SHUNT $738.58 20060701 99999999 62194 REPLACEMENT OR IRRIGATION, SUBARACHNOID/SUBDURAL CATHETER $206.84 20060701 99999999 62200 VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE $1,040.52 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 209
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Medicaid Fee Schedule without Mods 200801

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