Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 63660 REVISION OR REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODES $351.13 20060701 99999999 63685 INCISION FOR SUBCUTANEOUS PLACEMENT OF NEUROSTIMULATOR $395.96 20060701 99999999 63688 REVISION OR REMOVAL OF SPINAL NEUROSTIMULATOR RECEIVER $311.41 20060701 99999999 63700 REPAIR OF MENINGOCELE $854.03 20060701 99999999 63702 REPAIR OF MENINGOCELE $963.39 20060701 99999999 63704 REPAIR OF MYELOMENINGOCELE $1,083.99 20060701 99999999 63706 REPAIR OF MYELOMENINGOCELE $1,193.94 20060701 99999999 63707 REPAIR OF DURAL/CSF LEAK NOT REQUIRING LAMINECTOMY $671.89 20060701 99999999 63709 REPAIR OF DURAL/CSF LEAK OR PSEUDOMENINGOCELE W/LAMINECTOMY $845.73 20060701 99999999 63710 DURAL GRAFT, SPINAL $742.15 20060701 99999999 63740 CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, $684.14 20060701 99999999 63741 CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, - PLEURAL, OR OTHER; PERCUTAN $476.90 20060701 99999999 63744 REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT $475.29 20060701 99999999 63746 REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT $339.09 20060701 99999999 64400 INJECTION, ANESTHETIC AGENT $39.26 20060701 99999999 64402 INJECTION, ANESTHETIC AGENT $52.68 20060701 99999999 64405 INJECTION, ANESTHETIC AGENT $47.73 20060701 99999999 64408 INJECTION, ANESTHETIC AGENT $58.77 20060701 99999999 64410 INJECTION, ANESTHETIC AGENT $56.10 20060701 99999999 64412 INJECTION, ANESTHETIC AGENT $42.29 20060701 99999999 64413 INJECTION, ANESTHETIC AGENT $51.14 20060701 99999999 64415 INJECTION, ANESTHETIC AGENT $50.44 20060701 99999999 64416 INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (I $116.52 20060701 99999999 64417 INJECTION, ANESTHETIC AGENT $55.93 20060701 99999999 64418 INJECTION, ANESTHETIC AGENT $48.47 20060701 99999999 64420 INJECTION, ANESTHETIC AGENT $47.71 20060701 99999999 64421 INJECTION, ANESTHETIC AGENT $66.30 20060701 99999999 64425 INJECTION, ANESTHETIC AGENT $64.65 20060701 99999999 64430 INJECTION, ANESTHETIC AGENT $59.01 20060701 99999999 64435 INJECTION, ANESTHETIC AGENT $53.48 20060701 99999999 64440 INJECTION, ANESTHETIC AGENT $59.28 19990701 99999999 64441 INJECTION, ANESTHETIC AGENT $78.18 19990701 99999999 64442 INJECTION, ANESTHETIC AGENT $68.55 19990701 99999999 64443 INJECTION, ANESTHETIC AGENT $44.07 19990701 99999999 64445 INJECTION, ANESTHETIC AGENT $50.49 20060701 99999999 64446 INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, CONTINUOUS INFUSION BY CATHETER, (IN $121.82 20060701 99999999 64447 INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, SINGLE $56.86 20060701 99999999 64448 INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INC $111.95 20060701 99999999 64449 INJECTION, ANESTHETIC AGENT; LUMBAR PLEXUS, POSTERIOR APPROACH, CONTINUOUS INFUS $112.15 20060701 99999999 64450 INJECTION, ANESTHETIC AGENT $45.03 20060701 99999999 64470 INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET J $66.04 20060701 99999999 64472 INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET J $47.12 20060701 99999999 64475 INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET J $50.52 20060701 99999999 64476 INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET J $35.03 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 214
PROC-CODE DESC MAC BEG END 64479 INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL OR $78.80 20060701 99999999 64480 INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL OR $54.51 20060701 99999999 64483 INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR S $67.16 20060701 99999999 64484 INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR S $47.17 20060701 99999999 64505 INJECTION, ANESTHETIC AGENT $49.57 20060701 99999999 64508 INJECTION, ANESTHETIC AGENT $47.71 20060701 99999999 64510 INJECTION, ANESTHETIC AGENT $49.70 20060701 99999999 64517 INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC PLEXUS $88.29 20060701 99999999 64520 INJECTION, ANESTHETIC AGENT $54.25 20060701 99999999 64530 INJECTION, ANESTHETIC AGENT $69.29 20060701 99999999 64550 APPLICATION OF SURFACE (TRANSCUTANEOUS) $8.98 20060701 99999999 64553 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR $103.05 20060701 99999999 64555 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR $85.39 20060701 99999999 64560 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR $91.94 20060701 99999999 64561 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE (TRANSFORA $387.86 20060701 99999999 64565 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR $74.42 20060701 99999999 64573 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR $355.35 20060701 99999999 64575 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR $234.46 20060701 99999999 64577 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR $243.07 20060701 99999999 64580 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR $220.87 20060701 99999999 64581 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE (TRANSFORA $555.71 20060701 99999999 64585 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODES $105.96 20060701 99999999 64590 INCISION FOR SUBCUTANEOUS PLACEMENT OF NEUROSTIMULATOR $139.81 20060701 99999999 64595 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR RECEIVER $98.94 20060701 99999999 64600 DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE $157.01 20060701 99999999 64605 DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE $222.34 20060701 99999999 64610 DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE $407.37 20060701 99999999 64612 DESTRUCTION BY NEUROLYTIC AGENT (CHEMODENERVATION OF MUSCLE ENDPLATE); MUSCLES E $92.20 20060701 99999999 64613 DESTRUCTION BY NEUROLYTIC AGENT (CHEMODENERVATION OF MUSCLE ENDPLATE); CERVICAL $91.18 20060701 99999999 64614 CHEMODENERVATION OF MUSCLE(S); EXTREMITY(S) AND/OR TRUNK MUSCLE(S) (EG, FOR DYST $124.74 20060701 99999999 64620 DESTRUCTION BY NEUROLYTIC AGENT $105.63 20060701 99999999 64622 DESTRUCTION BY NEUROLYTIC AGENT $125.68 20060701 99999999 64623 DESTRUCTION BY NEUROLYTIC AGENT $45.58 20060701 99999999 64626 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; CERVICAL OR TH $128.36 20060701 99999999 64627 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; CERVICAL OR TH $42.51 20060701 99999999 64630 DESTRUCTION BY NEUROLYTIC AGENT $125.14 20060701 99999999 64640 DESTRUCTION BY NEUROLYTIC AGENT $115.08 20060701 99999999 64650 CHEMODENERVATION OF ECCRINE GLANDS; BOTH AXILLAE $27.47 20060701 99999999 64653 CHEMODENERVATION OF ECCRINE GLANDS; OTHER AREA(S) (EG, SCALP, FACE, NECK), PER D $34.71 20060701 99999999 64680 DESTRUCTION BY NEUROLYTIC AGENT, CELIAC PLEXUS, WITH $109.13 20060701 99999999 64681 DESTRUCTION BY NEUROLYTIC AGENT, WITH OR WITHOUT RADIOLOGIC MONITORING; SUPERIOR $162.58 20060701 99999999 64702 NEUROPLASTY $248.34 20060701 99999999 64704 NEUROPLASTY $260.27 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 215
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