Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 69222 DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, WITH ANESTHESIA $86.47 20060701 99999999 69300 OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION $335.77 20060701 99999999 69310 RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) $674.12 20060701 99999999 69320 RECONSTRUCTION EXTERNAL AUDITORY CANAL FOR CONGENITAL ATRESIA, $965.06 20060701 99999999 69400 EUSTACHIAN TUBE INFLATION, TRANSNASAL $37.16 20060701 99999999 69401 EUSTACHIAN TUBE INFLATION, TRANSNASAL $31.73 20060701 99999999 69405 EUSTACHIAN TUBE CATHETERIZATION, TRANSTYMPANIC $122.53 20060701 99999999 69410 FOCAL APPLICATION OF PHASE CONTROL SUBSTANCE, MIDDLE EAR (BAFFLE $16.67 20030401 99999999 69420 MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE $72.56 20060701 99999999 69421 MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE $97.08 20060701 99999999 69424 VENTILATING TUBE REMOVAL WHEN ORIGINALLY INSERTED BY ANOTHER $40.09 20060701 99999999 69433 TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), LOCAL OR $78.53 20060701 99999999 69436 TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL $158.37 20060701 99999999 69440 MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL $455.43 20060701 99999999 69450 TYMPANOLYSIS, TRANSCANAL $342.78 20060701 99999999 69501 TRANSMASTOID ANTROTOMY (''SIMPLE'' MASTOIDECTOMY) $539.64 20060701 99999999 69502 MASTOIDECTOMY $727.00 20060701 99999999 69505 MASTOIDECTOMY $764.58 20060701 99999999 69511 MASTOIDECTOMY $793.37 20060701 99999999 69530 PETROUS APICECTOMY INCLUDING RADICAL MASTOIDECTOMY $1,043.24 20060701 99999999 69535 RESECTION TEMPORAL BONE, EXTERNAL APPROACH $1,809.83 20060701 99999999 69540 EXCISION AURAL POLYP $79.26 20060701 99999999 69550 EXCISION AURAL GLOMUS TUMOR $649.05 20060701 99999999 69552 EXCISION AURAL GLOMUS TUMOR $1,045.66 20060701 99999999 69554 EXCISION AURAL GLOMUS TUMOR $1,663.32 20060701 99999999 69601 REVISION MASTOIDECTOMY $776.40 20060701 99999999 69602 REVISION MASTOIDECTOMY $796.51 20060701 99999999 69603 REVISION MASTOIDECTOMY $821.56 20060701 99999999 69604 REVISION MASTOIDECTOMY $820.63 20060701 99999999 69605 REVISION MASTOIDECTOMY $983.87 20060701 99999999 69610 TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION $190.42 20060701 99999999 69620 MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA) $329.88 20060701 99999999 69631 TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, $590.44 20060701 99999999 69632 TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, $758.45 20060701 99999999 69633 TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, $722.62 20060701 99999999 69635 TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING $784.69 20060701 99999999 69636 TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING $897.81 20060701 99999999 69637 TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING $890.92 20060701 99999999 69641 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $750.22 20060701 99999999 69642 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $987.54 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 224
PROC-CODE DESC MAC BEG END 69643 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $903.19 20060701 99999999 69644 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $994.02 20060701 99999999 69645 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $961.59 20060701 99999999 69646 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $1,052.75 20060701 99999999 69650 STAPES MOBILIZATION $571.51 20060701 99999999 69660 STAPEDECTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, $696.53 20060701 99999999 69661 STAPEDECTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, $917.11 20060701 99999999 69662 REVISION OF STAPEDECTOMY OR STAPEDOTOMY $900.11 20060701 99999999 69666 REPAIR OVAL WINDOW FISTULA $576.99 20060701 99999999 69667 REPAIR ROUND WINDOW FISTULA $577.26 20060701 99999999 69670 MASTOID OBLITERATION (SEPARATE PROCEDURE) $639.22 20060701 99999999 69676 TYMPANIC NEURECTOMY $536.51 20060701 99999999 69700 CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE PROCEDURE) $453.54 20060701 99999999 69711 REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION DEVICE $567.15 20060701 99999999 69714 IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS ATTACHME $723.52 20060701 99999999 69715 IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS ATTACHME $914.52 20060701 99999999 69717 REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, TEM $748.46 20060701 99999999 69718 REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, TEM $925.85 20060701 99999999 69720 DECOMPRESSION FACIAL NERVE, INTRATEMPORAL $849.88 20060701 99999999 69725 DECOMPRESSION FACIAL NERVE, INTRATEMPORAL $1,228.96 20060701 99999999 69740 SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR $818.30 20060701 99999999 69745 SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR $933.13 20060701 99999999 69801 LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY OR OTHER $511.24 20060701 99999999 69802 LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY OR OTHER $719.78 20060701 99999999 69805 ENDOLYMPHATIC SAC OPERATION $768.15 20060701 99999999 69806 ENDOLYMPHATIC SAC OPERATION $730.32 20060701 99999999 69820 FENESTRATION SEMICIRCULAR CANAL $566.86 20060701 99999999 69840 REVISION FENESTRATION OPERATION $582.10 20060701 99999999 69905 LABYRINTHECTOMY $659.12 20060701 99999999 69910 LABYRINTHECTOMY $798.08 20060701 99999999 69915 VESTIBULAR NERVE SECTION, TRANSLABYRINTHINE APPROACH $1,130.49 20060701 99999999 69930 COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY $972.60 20060701 99999999 69950 VESTIBULAR NERVE SECTION, TRANSCRANIAL APPROACH $1,290.71 20060701 99999999 69955 TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR (MAY INCLUDE GRAFT) $1,402.57 20060701 99999999 69960 DECOMPRESSION INTERNAL AUDITORY CANAL $1,352.34 20060701 99999999 69970 REMOVAL OF TUMOR, TEMPORAL BONE $1,475.41 20060701 99999999 69990 USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO $155.12 20060701 99999999 70010 MYELOGRAPHY, POSTERIOR FOSSA $188.91 20060701 99999999 70015 CISTERNOGRAPHY, POSITIVE CONTRAST $91.40 20060701 99999999 70030 RADIOLOGIC EXAMINATION, EYE, $21.02 20060701 99999999 70100 RADIOLOGIC EXAMINATION, MANDIBLE $27.78 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 225
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Medicaid Fee Schedule without Mods 200801

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