Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 62201 VENTRICULUOCISTERNOSTOMY 3RD VENTRICLE STEREOTACTIC METHOD $761.93 20060701 99999999 62220 CREATION OF SHUNT $782.43 20060701 99999999 62223 CREATION OF SHUNT $772.07 20060701 99999999 62225 REPLACEMENT OR IRRIGATION, VENTRICULAR CATHETER $313.32 20060701 99999999 62230 REPLACEMENT OR REVISION OF CSF SHUNT, OBSTRUCTED VALVE, OR $599.10 20060701 99999999 62252 REPROGRAMMING OF PROGRAMMABLE CSF SHUNT $62.69 20060701 99999999 62256 REMOVAL OF COMPLETE CSF SHUNT SYSTEM $396.88 20060701 99999999 62258 REMOVAL OF COMPLETE CSF SHUNT SYSTEM $839.04 20060701 99999999 62263 PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG, HYPERTONI $248.50 20060701 99999999 62264 PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG, HYPERTONI $162.90 20060701 99999999 62268 PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX $217.91 20060701 99999999 62269 BIOPSY OF SPINAL CORD, PERCUTANEOUS NEEDLE $202.42 20060701 99999999 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC $51.03 20060701 99999999 62272 SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF SPINAL FLUID $65.87 20060701 99999999 62273 INJECTION, LUMBAR EPIDURAL, OF BLOOD OR CLOT PATCH $94.08 20060701 99999999 62274 INJECTION OF ANESTHETIC SUBSTANCE (INCLUDING NARCOTICS), $73.24 19990701 99999999 62275 INJECTION OF ANESTHETIC SUBSTANCE (INCLUDING NARCOTICS), DIAGNOSTIC OR THERAPEUT $71.01 19990701 99999999 62276 INJECTION OF ANESTHETIC SUBSTANCE (INCLUDING NARCOTICS), $90.25 19990701 99999999 62277 INJECTION OF ANESTHETIC SUBSTANCE (INCLUDING NARCOTICS), $87.22 19990701 99999999 62278 INJECTION OF ANESTHETIC SUBSTANCE (INCLUDING NARCOTICS), $68.07 19990701 99999999 62279 INJECTION OF ANESTHETIC SUBSTANCE (INCLUDING NARCOTICS), $67.72 19990701 99999999 62280 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, $95.93 20060701 99999999 62281 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); $97.27 20060701 99999999 62282 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, $102.18 20060701 99999999 62284 INJECTION PROCEDURE FOR MYELOGRAPHY AND/OR COMPUTERIZED $78.52 20060701 99999999 62287 ASPIRATION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DISK, $420.88 20060701 99999999 62288 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, CONTRAST, $78.93 19990701 99999999 62289 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, CONTRAST, $73.98 19990701 99999999 62290 INJECTION PROCEDURE FOR DISKOGRAPHY, SINGLE OR MULTIPLE $131.61 20060701 99999999 62291 INJECTION PROCEDURE FOR DISKOGRAPHY, SINGLE OR MULTIPLE $126.12 20060701 99999999 62292 INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS, INCLUDING DISKOGRAPHY, $431.10 20060701 99999999 62294 INJECTION PROCEDURE, ARTERIAL, FOR OCCLUSION OF $519.82 20060701 99999999 62298 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, CONTRAST, OR NEUROLYTIC SOLUTIONS, $92.28 19990701 99999999 62310 INJECTION, SINGLE (NOT VIA INDWELLING CATHETER), NOT INCLUDING NEUROLYTIC SUBSTA $68.64 20060701 99999999 62311 INJECTION, SINGLE (NOT VIA INDWELLING CATHETER), NOT INCLUDING NEUROLYTIC SUBSTA $57.10 20060701 99999999 62318 INJECTION, INCLUDING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOL $74.20 20060701 99999999 62319 INJECTION, INCLUDING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOL $67.15 20060701 99999999 62350 IMPLANTATION, REVISION OR REPOSITIONING OF INTRATHECAL OR EPIDURAL CATHETER, FOR $308.61 20060701 99999999 62351 IMPLANTATION, REVISION OR REPOSITIONING OF INTRATHECAL OR EPIDURAL CATHETER, FOR $496.00 20060701 99999999 62355 REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER $255.38 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 210
PROC-CODE DESC MAC BEG END 62360 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; $134.02 20060701 99999999 62361 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; $246.93 20060701 99999999 62362 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; $326.60 20060701 99999999 62365 REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL $265.18 20060701 99999999 62367 ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL $22.00 20060701 99999999 62368 ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL $33.72 20060701 99999999 63001 LAMINECTOMY FOR EXPLORATION/DECOMPRESSION OF SPINAL CORD $955.82 20060701 99999999 63003 LAMINECTOMY FOR EXPLORATION/DECOMPRESSION OF SPINAL CORD $966.24 20060701 99999999 63005 LAMINECTOMY FOR EXPLORATION/DECOMPRESSION OF SPINAL CORD $898.89 20060701 99999999 63011 LAMINECTOMY FOR EXPLORATION/DECOMPRESSION OF SPINAL CORD $734.51 20060701 99999999 63012 LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS AND/OR PARS INTER-ARTICULARIS WITH D $906.15 20060701 99999999 63015 LAMINECTOMY FOR EXPLORATION/DECOMPRESSION OF SPINAL CORD $1,166.02 20060701 99999999 63016 LAMINECTOMY FOR EXPLORATION/DECOMPRESSION OF SPINAL CORD $1,153.59 20060701 99999999 63017 LAMINECTOMY FOR EXPLORATION/DECOMPRESSION OF SPINAL CORD $961.89 20060701 99999999 63020 LAMINOTOMY (HEMILAMINECTOMY), FOR DECOMPRESSION OF NERVE $900.45 20060701 99999999 63030 LAMINOTOMY (HEMILAMINECTOMY), FOR DECOMPRESSION OF NERVE $738.67 20060701 99999999 63035 LAMINOTOMY (HEMILAMINECTOMY), FOR DECOMPRESSION OF NERVE $180.22 20060701 99999999 63040 LAMINOTOMY (HEMILAMINECTOMY), FOR DECOMPRESSION OF NERVE $1,126.14 20060701 99999999 63042 LAMINOTOMY (HEMILAMINECTOMY), FOR DECOMPRESSION OF NERVE $1,046.52 20060701 99999999 63045 LAMINECTOMY INCL UNILAT OR BILAT CMPLT FACETECTOMY OR FORAMI $999.40 20060701 99999999 63046 LAMINECTOMY INCL UNIL/BILAT CMPLT FACETECTOMY OR FORAMINOTOM $956.79 20060701 99999999 63047 LAMINECTOMY INCL UNIL/BILAT CMPLT FACETECTOMY OR FORAMINOTOM $882.74 20060701 99999999 63048 LAMINECTOMY INCL UNIL/BILAT CMPLT FACETECTOMY OR FORAMINOTOM $186.23 20060701 99999999 63050 LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, TWO OR MORE $1,029.23 20060701 99999999 63051 LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, TWO OR MORE $1,174.55 20060701 99999999 63055 TRANSPEDICULAR APPROACH FOR DECOMPRESSION OF SPINAL CORD $1,307.28 20060701 99999999 63056 TRANSPEDICULAR APPROACH FOR DECOMPRESSION OF SPINAL CORD $1,192.98 20060701 99999999 63057 TRANSPEDICULAR APPROACH FOR DECOMPRESSION OF SPINAL CORD $267.29 20060701 99999999 63064 COSTOVERTEBRAL APPROACH FOR DECOMPRESSION OF SPINAL CORD OR $1,413.88 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 211
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