Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 66940 EXTRACTION OF LENS WITH OR WITHOUT IRIDECTOMY $534.71 20060701 99999999 66982 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ON $778.50 20060701 99999999 66983 INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF $494.28 20060701 99999999 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF $584.09 20060701 99999999 66985 INSERTION OF INTRAOCULAR LENS SUBSEQUENT TO CATARACT $484.39 20060701 99999999 66986 EXCHANGE OF INTRAOCULAR LENS $673.14 20060701 99999999 67005 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE $306.43 20060701 99999999 67010 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE $369.97 20060701 99999999 67015 ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR $416.20 20060701 99999999 67025 INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA APPROACH $411.60 20060701 99999999 67027 IMPLANTATION OR REPLACEMENT OF INTRAVITREAL DRUG DELIVERY SYSTEM (EG, GANCICLOVI $590.72 20060701 99999999 67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE) $135.55 20060701 99999999 67030 DISCISSION OF VITREOUS STRANDS (WITHOUT REMOVAL), PARS PLANA $318.92 20060701 99999999 67031 SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, $181.47 20060701 99999999 67036 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH $821.70 20060701 99999999 67038 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH $1,209.64 19990701 99999999 67039 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL ENDOLASER PHOTOCOAGULATI $847.98 20060701 99999999 67040 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH $1,214.68 20060701 99999999 67041 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF PRERETINAL CELLULAR $595.81 20080101 99999999 67042 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF INTERNAL LIMITING M $680.36 20080101 99999999 67043 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF SUBRETINAL MEMBRANE $715.45 20080101 99999999 67101 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $406.49 20060701 99999999 67105 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $365.66 20060701 99999999 67107 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $881.22 20060701 99999999 67108 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $1,430.57 20060701 99999999 67110 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; BY INJECTION OF AIR OR OTHER $555.94 20060701 99999999 67112 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $976.62 20060701 99999999 67113 REPAIR OF COMPLEX RETINAL DETACHMENT (EG, PROLIFERATIVE VITREORETINOPATHY, STAGE $718.34 20080101 99999999 67115 RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT) $326.30 20060701 99999999 67120 REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT $378.24 20060701 99999999 67121 REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT $627.47 20060701 99999999 67141 PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE $290.59 20060701 99999999 67145 PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE $266.00 20060701 99999999 67208 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, $350.59 20060701 99999999 67210 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, $408.38 20060701 99999999 67218 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, $793.79 20060701 99999999 67220 DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION), O $564.34 20060701 99999999 67221 DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION); P $216.25 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 220
PROC-CODE DESC MAC BEG END 67225 DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION); P $26.23 20060701 99999999 67227 DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, $407.87 20060701 99999999 67228 DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, $544.54 20060701 99999999 67229 TREATMENT OF EXTENSIVE OR PROGRESSIVE RETINOPATHY, ONE OR MORE SESSIONS; PRETERM $519.84 20080101 99999999 67250 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE) $517.69 20060701 99999999 67255 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE) $572.28 20060701 99999999 67299 UNLISTED PROCEDURE, POSTERIOR SEGMENT $738.96 19990701 99999999 67311 STRABISMUS SURGERY ON PATIENT NOT PREVIOUSLY OPERATED ON, ANY $402.54 20060701 99999999 67312 STRABISMUS SURGERY ON PATIENT NOT PREVIOUSLY OPERATED ON, ANY $503.99 20060701 99999999 67314 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPE $448.96 20060701 99999999 67316 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPE $558.10 20060701 99999999 67318 STRABISMUS SURGERY, ANY PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON), SUPERIOR $429.51 20060701 99999999 67320 TRANSPOSITION OF EXTRAOCULAR MUSCLE (EG, FOR PARETIC MUSCLE), $246.44 20060701 99999999 67331 STRABISMUS SURGERY ON PATIENT PREVIOUSLY OPERATED ON $233.85 20060701 99999999 67332 STRABISMUS SURGERY ON PATIENT PREVIOUSLY OPERATED ON $255.37 20060701 99999999 67334 STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT MUSCL $225.78 20060701 99999999 67335 ADJUSTABLE SUTURE TECHNIQUE DURING STRABISMUS SURGERY $133.83 20060701 99999999 67340 STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR M $280.91 20060701 99999999 67343 RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE (SEPARATE $407.43 20060701 99999999 67345 CHEMODENERVATION OF EXTRAOCULAR MUSCLE $126.45 20060701 99999999 67346 BIOPSY OF EXTRAOCULAR MUSCLE $125.95 20070101 99999999 67350 BIOPSY OF EXTRAOCULAR MUSCLE $155.56 19990701 99999999 67400 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL APPROACH) $630.29 20060701 99999999 67405 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL APPROACH) $525.31 20060701 99999999 67412 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL APPROACH) $642.90 20060701 99999999 67413 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL APPROACH) $592.26 20060701 99999999 67414 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOV $667.35 20060701 99999999 67415 TRANSCONJUNCTIVAL OR ASPIRATIONAL BIOPSY $94.41 20060701 99999999 67420 ORBITOTOMY WITH BONE FLAP, LATERAL APPROACH (EG, KROENLEIN) $1,121.32 20060701 99999999 67430 ORBITOTOMY WITH BONE FLAP, LATERAL APPROACH (EG, KROENLEIN) $784.07 20060701 99999999 67440 ORBITOTOMY WITH BONE FLAP, LATERAL APPROACH (EG, KROENLEIN) $823.57 20060701 99999999 67445 ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH REMO $825.08 20060701 99999999 67450 ORBITOTOMY WITH BONE FLAP, LATERAL APPROACH (EG, KROENLEIN) $851.67 20060701 99999999 67500 RETROBULBAR INJECTION $37.86 20060701 99999999 67505 RETROBULBAR INJECTION $33.49 20060701 99999999 67515 INJECTION OF THERAPEUTIC AGENT INTO TENON'S CAPSULE $26.47 20060701 99999999 67550 ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE) $618.16 20060701 99999999 67560 ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE) $608.73 20060701 99999999 67570 OPTIC NERVE DECOMPRESSION (EG, INCISION OR FENESTRATION OF OPTIC NERVE SHEATH) $742.21 20060701 99999999 67700 BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID $64.21 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 221
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