Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
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PROC-CODE DESC MAC BEG END<br />
64837 SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT $305.47 20060701 99999999<br />
64840 SUTURE OF POSTERIOR TIBIAL NERVE $680.00 20060701 99999999<br />
64856 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, $676.98 20060701 99999999<br />
64857 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, $725.57 20060701 99999999<br />
64858 SUTURE OF SCIATIC NERVE $835.80 20060701 99999999<br />
64859 SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE $217.89 20060701 99999999<br />
64861 SUTURE OF $976.31 20060701 99999999<br />
64862 SUTURE OF $1,156.04 20060701 99999999<br />
64864 SUTURE OF FACIAL NERVE $619.37 20060701 99999999<br />
64865 SUTURE OF FACIAL NERVE $803.71 20060701 99999999<br />
64866 ANASTOMOSIS $791.93 20060701 99999999<br />
64868 ANASTOMOSIS $745.68 20060701 99999999<br />
64870 ANASTOMOSIS $842.60 20060701 99999999<br />
64872 SUTURE OF NERVE $99.05 20060701 99999999<br />
64874 SUTURE OF NERVE $146.64 20060701 99999999<br />
64876 SUTURE OF NERVE $160.29 20060701 99999999<br />
64885<br />
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO<br />
4 CM IN LENGTH $884.87 20060701 99999999<br />
64886<br />
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE<br />
THAN 4 CM IN LENGTH $1,048.11 20060701 99999999<br />
64890 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, $797.64 20060701 99999999<br />
64891 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, $793.31 20060701 99999999<br />
64892 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, $751.97 20060701 99999999<br />
64893 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, $845.89 20060701 99999999<br />
64895 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS $958.01 20060701 99999999<br />
64896 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS $1,084.15 20060701 99999999<br />
64897 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS $905.58 20060701 99999999<br />
64898 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS $990.76 20060701 99999999<br />
64901 NERVE GRAFT, EACH ADDITIONAL NERVE $556.80 20060701 99999999<br />
64902 NERVE GRAFT, EACH ADDITIONAL NERVE $631.92 20060701 99999999<br />
64905 NERVE PEDICLE TRANSFER $675.81 20060701 99999999<br />
64907 NERVE PEDICLE TRANSFER $939.45 20060701 99999999<br />
64910<br />
NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT (EG,<br />
NERVE TUBE), EACH NE $458.90 20070101 99999999<br />
64911<br />
NERVE REPAIR; WITH AUTOGENOUS VEIN GRAFT (INCLUDES<br />
HARVEST OF VEIN GRAFT), EACH $556.87 20070101 99999999<br />
64999 UNLISTED PROCEDURE, NERVOUS SYSTEM $932.99 19990701 99999999<br />
65091 EVISCERATION OF OCULAR CONTENTS $447.75 20060701 99999999<br />
65093 EVISCERATION OF OCULAR CONTENTS $469.40 20060701 99999999<br />
65101 ENUCLEATION OF EYE $478.48 20060701 99999999<br />
65103 ENUCLEATION OF EYE $506.40 20060701 99999999<br />
65105 ENUCLEATION OF EYE $556.00 20060701 99999999<br />
65110<br />
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT),<br />
REMOVAL $852.84 20060701 99999999<br />
65112<br />
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT),<br />
REMOVAL $895.29 20060701 99999999<br />
65114<br />
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT),<br />
REMOVAL $941.19 20060701 99999999<br />
65125<br />
MODIFICATION OF OCULAR IMPLANT (EG, DRILLING RECEPTACLE FOR<br />
PROSTHESIS APPENDAGE $152.85 20030401 99999999<br />
65130 INSERTION OF OCULAR IMPLANT SECONDARY $480.38 20060701 99999999<br />
65135 INSERTION OF OCULAR IMPLANT SECONDARY $442.96 20060701 99999999<br />
65140 INSERTION OF OCULAR IMPLANT SECONDARY $481.95 20060701 99999999<br />
65150 REINSERTION OF OCULAR IMPLANT $430.14 20060701 99999999<br />
65155 REINSERTION OF OCULAR IMPLANT $566.60 20060701 99999999<br />
65175 REMOVAL OF OCULAR IMPLANT $431.60 20060701 99999999<br />
65205 REMOVAL OF FOREIGN BODY, EXTERNAL EYE $25.92 20060701 99999999<br />
65210 REMOVAL OF FOREIGN BODY, EXTERNAL EYE $31.84 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 217