Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 64708 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG $364.73 20060701 99999999 64712 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG $438.31 20060701 99999999 64713 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG $554.15 20060701 99999999 64714 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG $452.00 20060701 99999999 64716 NEUROPLASTY AND/OR TRANSPOSITION $336.15 20060701 99999999 64718 NEUROPLASTY AND/OR TRANSPOSITION $361.76 20060701 99999999 64719 NEUROPLASTY AND/OR TRANSPOSITION $289.07 20060701 99999999 64721 NEUROPLASTY AND/OR TRANSPOSITION $287.36 20060701 99999999 64722 DECOMPRESSION $266.26 20060701 99999999 64726 DECOMPRESSION $175.85 20060701 99999999 64727 INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE $167.82 20060701 99999999 64732 TRANSECTION OR AVULSION OF $260.88 20060701 99999999 64734 TRANSECTION OR AVULSION OF $277.91 20060701 99999999 64736 TRANSECTION OR AVULSION OF $249.96 20060701 99999999 64738 TRANSECTION OR AVULSION OF $305.05 20060701 99999999 64740 TRANSECTION OR AVULSION OF $297.27 20060701 99999999 64742 TRANSECTION OR AVULSION OF $332.90 20060701 99999999 64744 TRANSECTION OR AVULSION OF $314.43 20060701 99999999 64746 TRANSECTION OR AVULSION OF $316.88 20060701 99999999 64752 TRANSECTION OR AVULSION OF $358.52 20060701 99999999 64755 TRANSECTION OR AVULSION OF $665.50 20060701 99999999 64760 TRANSECTION OR AVULSION OF $371.66 20060701 99999999 64761 TRANSECTION OR AVULSION OF $316.93 20060701 99999999 64763 TRANSECTION OR AVULSION OF OBTURATOR NERVE, EXTRAPELVIC, WITH $359.23 20060701 99999999 64766 TRANSECTION OR AVULSION OF OBTURATOR NERVE, INTRAPELVIC, $454.85 20060701 99999999 64771 TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL $407.11 20060701 99999999 64772 TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL $408.90 20060701 99999999 64774 EXCISION OF NEUROMA $249.83 20060701 99999999 64776 EXCISION OF NEUROMA $249.00 20060701 99999999 64778 EXCISION OF NEUROMA $158.98 20060701 99999999 64782 EXCISION OF NEUROMA $308.39 20060701 99999999 64783 EXCISION OF NEUROMA $191.07 20060701 99999999 64784 EXCISION OF NEUROMA $478.06 20060701 99999999 64786 EXCISION OF NEUROMA $820.78 20060701 99999999 64787 IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY $216.88 20060701 99999999 64788 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA $244.32 20060701 99999999 64790 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA $562.18 20060701 99999999 64792 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA $728.68 20060701 99999999 64795 BIOPSY OF NERVE $157.68 20060701 99999999 64802 SYMPATHECTOMY, CERVICAL $453.43 20060701 99999999 64804 SYMPATHECTOMY, CERVICOTHORACIC $769.25 20060701 99999999 64809 SYMPATHECTOMY, THORACOLUMBAR $688.81 20060701 99999999 64818 SYMPATHECTOMY, LUMBAR $541.85 20060701 99999999 64820 SYMPATHECTOMY, DIGITAL ARTERIES, WITH MAGNIFICATION, EACH DIGIT $536.69 20060701 99999999 64821 SYMPATHECTOMY; RADIAL ARTERY $456.60 20060701 99999999 64822 SYMPATHECTOMY; ULNAR ARTERY $456.60 20060701 99999999 64823 SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH $526.04 20060701 99999999 64831 SUTURE OF DIGITAL NERVE, HAND OR FOOT $432.62 20060701 99999999 64832 SUTURE OF DIGITAL NERVE, HAND OR FOOT $234.23 20060701 99999999 64834 SUTURE OF ONE NERVE, HAND OR FOOT $457.54 20060701 99999999 64835 SUTURE OF ONE NERVE, HAND OR FOOT $531.05 20060701 99999999 64836 SUTURE OF ONE NERVE, HAND OR FOOT $546.47 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 216
PROC-CODE DESC MAC BEG END 64837 SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT $305.47 20060701 99999999 64840 SUTURE OF POSTERIOR TIBIAL NERVE $680.00 20060701 99999999 64856 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, $676.98 20060701 99999999 64857 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, $725.57 20060701 99999999 64858 SUTURE OF SCIATIC NERVE $835.80 20060701 99999999 64859 SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE $217.89 20060701 99999999 64861 SUTURE OF $976.31 20060701 99999999 64862 SUTURE OF $1,156.04 20060701 99999999 64864 SUTURE OF FACIAL NERVE $619.37 20060701 99999999 64865 SUTURE OF FACIAL NERVE $803.71 20060701 99999999 64866 ANASTOMOSIS $791.93 20060701 99999999 64868 ANASTOMOSIS $745.68 20060701 99999999 64870 ANASTOMOSIS $842.60 20060701 99999999 64872 SUTURE OF NERVE $99.05 20060701 99999999 64874 SUTURE OF NERVE $146.64 20060701 99999999 64876 SUTURE OF NERVE $160.29 20060701 99999999 64885 NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO 4 CM IN LENGTH $884.87 20060701 99999999 64886 NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE THAN 4 CM IN LENGTH $1,048.11 20060701 99999999 64890 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, $797.64 20060701 99999999 64891 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, $793.31 20060701 99999999 64892 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, $751.97 20060701 99999999 64893 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, $845.89 20060701 99999999 64895 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS $958.01 20060701 99999999 64896 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS $1,084.15 20060701 99999999 64897 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS $905.58 20060701 99999999 64898 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS $990.76 20060701 99999999 64901 NERVE GRAFT, EACH ADDITIONAL NERVE $556.80 20060701 99999999 64902 NERVE GRAFT, EACH ADDITIONAL NERVE $631.92 20060701 99999999 64905 NERVE PEDICLE TRANSFER $675.81 20060701 99999999 64907 NERVE PEDICLE TRANSFER $939.45 20060701 99999999 64910 NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT (EG, NERVE TUBE), EACH NE $458.90 20070101 99999999 64911 NERVE REPAIR; WITH AUTOGENOUS VEIN GRAFT (INCLUDES HARVEST OF VEIN GRAFT), EACH $556.87 20070101 99999999 64999 UNLISTED PROCEDURE, NERVOUS SYSTEM $932.99 19990701 99999999 65091 EVISCERATION OF OCULAR CONTENTS $447.75 20060701 99999999 65093 EVISCERATION OF OCULAR CONTENTS $469.40 20060701 99999999 65101 ENUCLEATION OF EYE $478.48 20060701 99999999 65103 ENUCLEATION OF EYE $506.40 20060701 99999999 65105 ENUCLEATION OF EYE $556.00 20060701 99999999 65110 EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL $852.84 20060701 99999999 65112 EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL $895.29 20060701 99999999 65114 EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL $941.19 20060701 99999999 65125 MODIFICATION OF OCULAR IMPLANT (EG, DRILLING RECEPTACLE FOR PROSTHESIS APPENDAGE $152.85 20030401 99999999 65130 INSERTION OF OCULAR IMPLANT SECONDARY $480.38 20060701 99999999 65135 INSERTION OF OCULAR IMPLANT SECONDARY $442.96 20060701 99999999 65140 INSERTION OF OCULAR IMPLANT SECONDARY $481.95 20060701 99999999 65150 REINSERTION OF OCULAR IMPLANT $430.14 20060701 99999999 65155 REINSERTION OF OCULAR IMPLANT $566.60 20060701 99999999 65175 REMOVAL OF OCULAR IMPLANT $431.60 20060701 99999999 65205 REMOVAL OF FOREIGN BODY, EXTERNAL EYE $25.92 20060701 99999999 65210 REMOVAL OF FOREIGN BODY, EXTERNAL EYE $31.84 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 217
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Medicaid Fee Schedule without Mods 200801

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