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 />
69643 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $903.19 20060701 99999999<br />
69644 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $994.02 20060701 99999999<br />
69645 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $961.59 20060701 99999999<br />
69646 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, $1,052.75 20060701 99999999<br />
69650 STAPES MOBILIZATION $571.51 20060701 99999999<br />
69660<br />
STAPEDECTOMY WITH REESTABLISHMENT OF OSSICULAR<br />
CONTINUITY, $696.53 20060701 99999999<br />
69661<br />
STAPEDECTOMY WITH REESTABLISHMENT OF OSSICULAR<br />
CONTINUITY, $917.11 20060701 99999999<br />
69662 REVISION OF STAPEDECTOMY OR STAPEDOTOMY $900.11 20060701 99999999<br />
69666 REPAIR OVAL WINDOW FISTULA $576.99 20060701 99999999<br />
69667 REPAIR ROUND WINDOW FISTULA $577.26 20060701 99999999<br />
69670 MASTOID OBLITERATION (SEPARATE PROCEDURE) $639.22 20060701 99999999<br />
69676 TYMPANIC NEURECTOMY $536.51 20060701 99999999<br />
69700<br />
CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE<br />
PROCEDURE) $453.54 20060701 99999999<br />
69711<br />
REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION<br />
DEVICE $567.15 20060701 99999999<br />
69714<br />
IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE,<br />
WITH PERCUTANEOUS ATTACHME $723.52 20060701 99999999<br />
69715<br />
IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE,<br />
WITH PERCUTANEOUS ATTACHME $914.52 20060701 99999999<br />
69717<br />
REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE),<br />
OSSEOINTEGRATED IMPLANT, TEM $748.46 20060701 99999999<br />
69718<br />
REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE),<br />
OSSEOINTEGRATED IMPLANT, TEM $925.85 20060701 99999999<br />
69720 DECOMPRESSION FACIAL NERVE, INTRATEMPORAL $849.88 20060701 99999999<br />
69725 DECOMPRESSION FACIAL NERVE, INTRATEMPORAL $1,228.96 20060701 99999999<br />
69740<br />
SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT<br />
OR $818.30 20060701 99999999<br />
69745<br />
SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT<br />
OR $933.13 20060701 99999999<br />
69801 LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY OR OTHER $511.24 20060701 99999999<br />
69802 LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY OR OTHER $719.78 20060701 99999999<br />
69805 ENDOLYMPHATIC SAC OPERATION $768.15 20060701 99999999<br />
69806 ENDOLYMPHATIC SAC OPERATION $730.32 20060701 99999999<br />
69820 FENESTRATION SEMICIRCULAR CANAL $566.86 20060701 99999999<br />
69840 REVISION FENESTRATION OPERATION $582.10 20060701 99999999<br />
69905 LABYRINTHECTOMY $659.12 20060701 99999999<br />
69910 LABYRINTHECTOMY $798.08 20060701 99999999<br />
69915 VESTIBULAR NERVE SECTION, TRANSLABYRINTHINE APPROACH $1,130.49 20060701 99999999<br />
69930<br />
COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT<br />
MASTOIDECTOMY $972.60 20060701 99999999<br />
69950 VESTIBULAR NERVE SECTION, TRANSCRANIAL APPROACH $1,290.71 20060701 99999999<br />
69955<br />
TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR (MAY<br />
INCLUDE GRAFT) $1,402.57 20060701 99999999<br />
69960 DECOMPRESSION INTERNAL AUDITORY CANAL $1,352.34 20060701 99999999<br />
69970 REMOVAL OF TUMOR, TEMPORAL BONE $1,475.41 20060701 99999999<br />
69990<br />
USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO<br />
CODE FOR PRIMARY PRO $155.12 20060701 99999999<br />
70010 MYELOGRAPHY, POSTERIOR FOSSA $188.91 20060701 99999999<br />
70015 CISTERNOGRAPHY, POSITIVE CONTRAST $91.40 20060701 99999999<br />
70030 RADIOLOGIC EXAMINATION, EYE, $21.02 20060701 99999999<br />
70100 RADIOLOGIC EXAMINATION, MANDIBLE $27.78 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 225