Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 67710 SEVERING OF TARSORRHAPHY $54.79 20060701 99999999 67715 CANTHOTOMY (SEPARATE PROCEDURE) $65.79 20060701 99999999 67800 EXCISION OF CHALAZION $59.08 20060701 99999999 67801 EXCISION OF CHALAZION $78.29 20060701 99999999 67805 EXCISION OF CHALAZION $94.42 20060701 99999999 67808 EXCISION OF CHALAZION $199.12 20060701 99999999 67810 BIOPSY OF EYELID $58.85 20060701 99999999 67820 CORRECTION OF TRICHIASIS $35.21 20060701 99999999 67825 CORRECTION OF TRICHIASIS $71.81 20060701 99999999 67830 CORRECTION OF TRICHIASIS $107.30 20060701 99999999 67835 CORRECTION OF TRICHIASIS $325.77 20060701 99999999 67840 EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUT CLOSURE $90.12 20060701 99999999 67850 DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM) $81.46 20060701 99999999 67875 TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE) $78.56 20060701 99999999 67880 CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, $216.64 20060701 99999999 67882 CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, $301.15 20060701 99999999 67900 REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH) $326.89 20060701 99999999 67901 REPAIR OF BLEPHAROPTOSIS $421.77 20060701 99999999 67902 REPAIR OF BLEPHAROPTOSIS $424.71 20060701 99999999 67903 REPAIR OF BLEPHAROPTOSIS $395.64 20060701 99999999 67904 REPAIR OF BLEPHAROPTOSIS $403.82 20060701 99999999 67906 REPAIR OF BLEPHAROPTOSIS $374.41 20060701 99999999 67908 REPAIR OF BLEPHAROPTOSIS $327.43 20060701 99999999 67909 REDUCTION OF OVERCORRECTION OF PTOSIS $343.64 20060701 99999999 67911 CORRECTION OF LID RETRACTION $339.60 20060701 99999999 67912 CORRECTION OF LAGOPHTHALMOS, WITH IMPLANTATION OF UPPER EYELID LID LOAD (EG, GOL $317.82 20060701 99999999 67914 REPAIR OF ECTROPION $220.03 20060701 99999999 67915 REPAIR OF ECTROPION $146.57 20060701 99999999 67916 REPAIR OF ECTROPION $320.44 20060701 99999999 67917 REPAIR OF ECTROPION $376.05 20060701 99999999 67921 REPAIR OF ENTROPION $204.68 20060701 99999999 67922 REPAIR OF ENTROPION $142.38 20060701 99999999 67923 REPAIR OF ENTROPION $350.65 20060701 99999999 67924 REPAIR OF ENTROPION $356.71 20060701 99999999 67930 SUTURE OF RECENT WOUND, EYELID, INVOLVING $153.89 20060701 99999999 67935 SUTURE OF RECENT WOUND, EYELID, INVOLVING $313.08 20060701 99999999 67938 REMOVAL OF EMBEDDED FOREIGN BODY, EYELID $63.32 20060701 99999999 67950 CANTHOPLASTY (RECONSTRUCTION OF CANTHUS) $371.29 20060701 99999999 67961 EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, $353.02 20060701 99999999 67966 EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, $391.77 20060701 99999999 67971 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF $569.76 20060701 99999999 67973 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF $732.10 20060701 99999999 67974 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF $741.54 20060701 99999999 67975 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF $435.69 20060701 99999999 68020 INCISION OF CONJUNCTIVA, DRAINAGE OF CYST $62.96 20060701 99999999 68040 EXPRESSION OF CONJUNCTIVAL FOLLICLES, EG, FOR TRACHOMA $33.35 20060701 99999999 68100 BIOPSY OF CONJUNCTIVA $56.12 20060701 99999999 68110 EXCISION OF LESION, CONJUNCTIVA $83.77 20060701 99999999 68115 EXCISION OF LESION, CONJUNCTIVA $115.75 20060701 99999999 68130 EXCISION OF LESION, CONJUNCTIVA $242.70 20060701 99999999 68135 DESTRUCTION OF LESION, CONJUNCTIVA $85.37 20060701 99999999 68200 SUBCONJUNCTIVAL INJECTION $21.82 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 222
PROC-CODE DESC MAC BEG END 68320 CONJUNCTIVOPLASTY $328.63 20060701 99999999 68325 CONJUNCTIVOPLASTY $438.26 20060701 99999999 68326 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC $427.00 20060701 99999999 68328 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC $483.18 20060701 99999999 68330 REPAIR OF SYMBLEPHARON $300.57 20060701 99999999 68335 REPAIR OF SYMBLEPHARON $413.76 20060701 99999999 68340 REPAIR OF SYMBLEPHARON $226.88 20060701 99999999 68360 CONJUNCTIVAL FLAP $276.11 20060701 99999999 68362 CONJUNCTIVAL FLAP $452.38 20060701 99999999 68371 HARVESTING CONJUNCTIVAL ALLOGRAFT, LIVING DONOR $275.67 20060701 99999999 68400 INCISION, DRAINAGE OF LACRIMAL GLAND $86.30 20060701 99999999 68420 INCISION, DRAINAGE OF LACRIMAL SAC (DACRYOCYSTOTOMY OR $107.86 20060701 99999999 68440 SNIP INCISION OF LACRIMAL PUNCTUM $54.47 20060701 99999999 68500 EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR $568.09 20060701 99999999 68505 EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR $595.45 20060701 99999999 68510 BIOPSY OF LACRIMAL GLAND $225.30 20060701 99999999 68520 EXCISION OF LACRIMAL SAC (DACRYOCYSTECTOMY) $448.26 20060701 99999999 68525 BIOPSY OF LACRIMAL SAC $218.07 20060701 99999999 68530 REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PASSAGES $167.43 20060701 99999999 68540 EXCISION OF LACRIMAL GLAND TUMOR $565.08 20060701 99999999 68550 EXCISION OF LACRIMAL GLAND TUMOR $713.92 20060701 99999999 68700 PLASTIC REPAIR OF CANALICULI $321.70 20060701 99999999 68705 CORRECTION OF EVERTED PUNCTUM, CAUTERY $94.37 20060701 99999999 68720 DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL $525.96 20060701 99999999 68745 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA $454.77 20060701 99999999 68750 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA $516.63 20060701 99999999 68760 CLOSURE OF LACRIMAL PUNCTUM $82.35 20060701 99999999 68761 CLOSURE OF THE LACRIMAL PUNCTUM; BY PLUG, EACH $65.51 20060701 99999999 68770 CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE) $314.42 20060701 99999999 68801 DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION $59.78 20060701 99999999 68810 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION $112.94 20060701 99999999 68811 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION REQUIRING GEN ANESTHES $123.60 20060701 99999999 68815 PROBING OF NASOLACRIMAL DUCT, WITH/WITHOUT IRRIGATION WITH INSERTION OF TUBE/STE $147.46 20060701 99999999 68816 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH TRANSLUMINAL BALL $114.67 20080101 99999999 68840 PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT IRRIGATION $57.95 20060701 99999999 68850 INJECTION OF CONTRAST MEDIUM FOR DACRYOCYSTOGRAPHY $36.19 20060701 99999999 69000 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA $69.68 20060701 99999999 69005 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA $97.79 20060701 99999999 69020 DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS $88.30 20060701 99999999 69100 BIOPSY EXTERNAL EAR $34.48 20060701 99999999 69105 BIOPSY EXTERNAL AUDITORY CANAL $43.83 20060701 99999999 69110 EXCISION EXTERNAL EAR $197.02 20060701 99999999 69120 EXCISION EXTERNAL EAR $255.86 20060701 99999999 69140 EXCISION EXOSTOSIS(ES), EXTERNAL AUDITORY CANAL $530.23 20060701 99999999 69145 EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL $150.43 20060701 99999999 69150 RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION $715.85 20060701 99999999 69155 RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION $1,079.28 20060701 99999999 69200 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL $35.80 20060701 99999999 69205 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL $71.57 20060701 99999999 69210 REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH $22.98 20060701 99999999 69220 DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINE $38.68 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 223
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Medicaid Fee Schedule without Mods 200801

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