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 />
68320 CONJUNCTIVOPLASTY $328.63 20060701 99999999<br />
68325 CONJUNCTIVOPLASTY $438.26 20060701 99999999<br />
68326 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC $427.00 20060701 99999999<br />
68328 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC $483.18 20060701 99999999<br />
68330 REPAIR OF SYMBLEPHARON $300.57 20060701 99999999<br />
68335 REPAIR OF SYMBLEPHARON $413.76 20060701 99999999<br />
68340 REPAIR OF SYMBLEPHARON $226.88 20060701 99999999<br />
68360 CONJUNCTIVAL FLAP $276.11 20060701 99999999<br />
68362 CONJUNCTIVAL FLAP $452.38 20060701 99999999<br />
68371 HARVESTING CONJUNCTIVAL ALLOGRAFT, LIVING DONOR $275.67 20060701 99999999<br />
68400 INCISION, DRAINAGE OF LACRIMAL GLAND $86.30 20060701 99999999<br />
68420 INCISION, DRAINAGE OF LACRIMAL SAC (DACRYOCYSTOTOMY OR $107.86 20060701 99999999<br />
68440 SNIP INCISION OF LACRIMAL PUNCTUM $54.47 20060701 99999999<br />
68500<br />
EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR<br />
TUMOR $568.09 20060701 99999999<br />
68505<br />
EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR<br />
TUMOR $595.45 20060701 99999999<br />
68510 BIOPSY OF LACRIMAL GLAND $225.30 20060701 99999999<br />
68520 EXCISION OF LACRIMAL SAC (DACRYOCYSTECTOMY) $448.26 20060701 99999999<br />
68525 BIOPSY OF LACRIMAL SAC $218.07 20060701 99999999<br />
68530 REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PASSAGES $167.43 20060701 99999999<br />
68540 EXCISION OF LACRIMAL GLAND TUMOR $565.08 20060701 99999999<br />
68550 EXCISION OF LACRIMAL GLAND TUMOR $713.92 20060701 99999999<br />
68700 PLASTIC REPAIR OF CANALICULI $321.70 20060701 99999999<br />
68705 CORRECTION OF EVERTED PUNCTUM, CAUTERY $94.37 20060701 99999999<br />
68720 DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL $525.96 20060701 99999999<br />
68745 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA $454.77 20060701 99999999<br />
68750 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA $516.63 20060701 99999999<br />
68760 CLOSURE OF LACRIMAL PUNCTUM $82.35 20060701 99999999<br />
68761 CLOSURE OF THE LACRIMAL PUNCTUM; BY PLUG, EACH $65.51 20060701 99999999<br />
68770 CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE) $314.42 20060701 99999999<br />
68801 DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION $59.78 20060701 99999999<br />
68810 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION $112.94 20060701 99999999<br />
68811<br />
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION<br />
REQUIRING GEN ANESTHES $123.60 20060701 99999999<br />
68815<br />
PROBING OF NASOLACRIMAL DUCT, WITH/WITHOUT IRRIGATION WITH<br />
INSERTION OF TUBE/STE $147.46 20060701 99999999<br />
68816<br />
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION;<br />
WITH TRANSLUMINAL BALL $114.67 <strong>200801</strong>01 99999999<br />
68840 PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT IRRIGATION $57.95 20060701 99999999<br />
68850 INJECTION OF CONTRAST MEDIUM FOR DACRYOCYSTOGRAPHY $36.19 20060701 99999999<br />
69000 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA $69.68 20060701 99999999<br />
69005 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA $97.79 20060701 99999999<br />
69020 DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS $88.30 20060701 99999999<br />
69100 BIOPSY EXTERNAL EAR $34.48 20060701 99999999<br />
69105 BIOPSY EXTERNAL AUDITORY CANAL $43.83 20060701 99999999<br />
69110 EXCISION EXTERNAL EAR $197.02 20060701 99999999<br />
69120 EXCISION EXTERNAL EAR $255.86 20060701 99999999<br />
69140 EXCISION EXOSTOSIS(ES), EXTERNAL AUDITORY CANAL $530.23 20060701 99999999<br />
69145 EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL $150.43 20060701 99999999<br />
69150 RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION $715.85 20060701 99999999<br />
69155 RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION $1,079.28 20060701 99999999<br />
69200 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL $35.80 20060701 99999999<br />
69205 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL $71.57 20060701 99999999<br />
69210<br />
REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR<br />
BOTH $22.98 20060701 99999999<br />
69220 DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINE $38.68 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 223