Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 63066 COSTOVERTEBRAL APPROACH DECOMPRESSION OF SPINAL CORD OR NERV $167.08 20060701 99999999 63075 DISKECTOMY, ANTERIOR, FOR DECOMPRESSION OF SPINAL CORD AND/OR $1,103.69 20060701 99999999 63076 DISKECTOMY, ANTERIOR, FOR DECOMPRESSION OF SPINAL CORD AND/OR $233.00 20060701 99999999 63077 DISKECTOMY ANTERIOR FOR DECOMPRESSION OF SPINAL CORD AND/OR $1,174.80 20060701 99999999 63078 DISKECTOMY ANTERIOR FOR DECOMPRESSION OF SPINAL CORD AND/OR $166.83 20060701 99999999 63081 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), $1,421.13 20060701 99999999 63082 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), $251.15 20060701 99999999 63085 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), $1,556.08 20060701 99999999 63086 VERTEBRAL CORPECTOMY PARTIAL OR COMPLT TRANSTHORACIC APPROAC $181.70 20060701 99999999 63087 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), $1,875.07 20060701 99999999 63088 VERTEBRAL CORPECTOMY PARTIAL OR CMPLT COMBINED THORACOLUMBAR $245.28 20060701 99999999 63090 VERTEBRAL CORPECTOMY PART OR CMPLT TRANSPERITONEAL OR RETROP $1,605.39 20060701 99999999 63091 VERTEBRAL CORPECTOMY PART OR CMPLT TRANSPERITONEAL OR RETROP $159.50 20060701 99999999 63101 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL EX $1,568.27 20060701 99999999 63102 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL EX $1,568.27 20060701 99999999 63103 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL EX $186.11 20060701 99999999 63170 LAMINECTOMY FOR MYELOTOMY (EG, BISCHOF OR DREZ TYPE), $1,147.51 20060701 99999999 63172 LAMINECTOMY FOR DRAINAGE OF INTRAMEDULLARY CYST/STRINX TO $1,078.66 20060701 99999999 63173 LAMINECTOMY DRAINAGE OF INTRAMEDULLARY CYST/SYRINK TO PERITO $1,179.10 20060701 99999999 63180 LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, $947.70 20060701 99999999 63182 LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, $1,093.41 20060701 99999999 63185 LAMINECTOMY FOR RHIZOTOMY $866.90 20060701 99999999 63190 LAMINECTOMY FOR RHIZOTOMY $1,039.16 20060701 99999999 63191 LAMINECTOMY FOR SECTION OF SPINAL ACCESSORY NERVE $920.89 20060701 99999999 63194 LAMINECTOMY FOR CORDOTOMY, UNILATERAL, ONE STAGE $1,011.87 20060701 99999999 63195 LAMINECTOMY FOR CORDOTOMY, UNILATERAL, ONE STAGE $1,021.83 20060701 99999999 63196 LAMINECTOMY FOR CORDOTOMY, BILATERAL, ONE STAGE $1,146.95 20060701 99999999 63197 LAMINECTOMY FOR CORDOTOMY, BILATERAL, ONE STAGE $1,093.77 20060701 99999999 63198 LAMINECTOMY FOR CORDOTOMY, BILATERAL, TWO STAGES WITHIN $1,231.73 20060701 99999999 63199 LAMINECTOMY FOR CORDOTOMY, BILATERAL, TWO STAGES WITHIN $1,441.73 20060701 99999999 63200 LAMINECTOMY FOR RELEASE OF TETHERED SPINAL CORD LUMBAR $999.37 20060701 99999999 63250 LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS $2,024.60 20060701 99999999 63251 LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS $2,024.89 20060701 99999999 63252 LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFO $2,106.70 20060701 99999999 63265 LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN $1,245.95 20060701 99999999 63266 LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN NEOPLASM $1,321.52 20060701 99999999 63267 LAMINECTOMY EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLA $1,063.61 20060701 99999999 63268 LAMINECTOMY EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLA $931.00 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 212
PROC-CODE DESC MAC BEG END 63270 LAMINECTOMY EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLA $1,394.55 20060701 99999999 63271 LAMINECTOMY EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLA $1,539.21 20060701 99999999 63272 LAMINECTOMY EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLA $1,411.69 20060701 99999999 63273 LAMINECTOMY EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLA $1,280.33 20060701 99999999 63275 LAMINECTOMY FOR BIOPSY/EXCISION INTRASPINAL NEOPLASM EXTRADU $1,393.78 20060701 99999999 63276 LAMINECTOMY FOR BIOPSY/EXCISION INTRASPINAL NEOPLASM EXTRADU $1,373.20 20060701 99999999 63277 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM EXTRADURAL LUM $1,226.48 20060701 99999999 63278 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM EXTRADURAL SAC $1,209.19 20060701 99999999 63280 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM INTRADURAL EXT $1,621.05 20060701 99999999 63281 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM INTRADURAL EXT $1,599.67 20060701 99999999 63282 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM INTRADURAL EXT $1,474.94 20060701 99999999 63283 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM INTRADURAL SAC $1,297.20 20060701 99999999 63285 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM INTRADURAL INT $1,861.60 20060701 99999999 63286 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM INTRADURAL INT $1,913.64 20060701 99999999 63287 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM INTRADURAL INT $1,912.98 20060701 99999999 63290 LAMINECTOMY FOR BIOP/EXC INTRASPINAL NEOPLASM COMB EXTRADURA $1,953.54 20060701 99999999 63295 OSTEOPLASTIC RECONSTRUCTION OF DORSAL SPINAL ELEMENTS, FOLLOWING PRIMARY $231.16 20060701 99999999 63300 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXCISION OF INTRASPIN $1,276.06 20060701 99999999 63301 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXCISION INTRASPINAL $1,402.98 20060701 99999999 63302 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXCISION INTRASPINAL $1,460.08 20060701 99999999 63303 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXC INTRASPINAL LESIO $1,494.60 20060701 99999999 63304 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXC INTRASPINAL LESIO $1,596.05 20060701 99999999 63305 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXC INTRASPINAL LESIO $1,636.86 20060701 99999999 63306 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXC INTRASPINAL LESIO $1,650.31 20060701 99999999 63307 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXC INTRASPINAL LESIO $1,607.85 20060701 99999999 63308 VERTEBRAL CORPECTOMY PART OR CMPLT FOR EXC INTRASPINAL LESIO $270.46 20060701 99999999 63600 CREATION OF LESION OF SPINAL CORD BY STEREOTACTIC METHOD, $675.34 20060701 99999999 63610 STEREOTACTIC STIMULATION OF SPINAL CORD, PERCUTANEOUS, $402.31 20060701 99999999 63615 STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION OF LESION, $857.19 20060701 99999999 63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR $358.00 20060701 99999999 63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR $616.30 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 213
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Medicaid Fee Schedule without Mods 200801

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