Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 75993 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERV $290.97 19990701 99999999 75994 TRANSLUMINAL ATHERECTOMY, RENAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION $571.20 19990701 99999999 75995 TRANSLUMINAL ATHERECTOMY, VISCERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION $570.08 19990701 99999999 75996 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL RENAL OR VISCERAL ARTERY, RADIOLOGICAL $290.66 19990701 99999999 75998 FLUOROSCOPIC GUIDANCE FOR CENTRAL VENOUS ACCESS DEVICE PLACEMENT, REPLACEMENT (C $57.02 20040101 99999999 76000 FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, $49.90 20060701 99999999 76001 FLUOROSCOPY, PHYSICIAN TIME MORE THAN ONE HOUR, ASSISTING A $113.08 20060701 99999999 76003 FLUOROSCOPIC LOCALIZATION FOR NEEDLE BIOPSY OR FINE $64.25 19990701 99999999 76005 FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE OR PA $80.72 20000101 99999999 76006 RADIOLOGIC EXAMINATION, STRESS VIEW(S), ANY JOINT, STRESS APPLIED BY A PHYSICIAN $19.73 19990701 99999999 76010 RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR FOREIGN $24.20 20060701 99999999 76020 BONE AGE STUDIES $24.78 19990701 99999999 76040 BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM) $36.74 19990701 99999999 76061 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY $50.71 19990701 99999999 76062 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY $68.86 19990701 99999999 76065 RADIOLOGIC EXAMINATION OSSEOUS SURVEY $35.45 19990701 99999999 76066 JOINT SURVEY, SINGLE VIEW, ONE OR MORE JOINTS (SPECIFY) $49.27 19990701 99999999 76070 COMPUTERIZED TOMOGRAPHY, BONE DENSITY STUDY $102.72 20020101 99999999 76071 COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, ONE OR MORE SITES; APPENDICULAR $96.52 20030401 99999999 76075 DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA), BONE DENSITY STUDY $113.64 19990701 99999999 76076 DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA), BONE DENSITY STUDY, ONE OR MORE SITES; $33.87 19990701 99999999 76077 DUAL ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, ONE OR MORE SITES; $30.66 20050101 99999999 76078 RADIOGRAPHIC ABSORPTIOMETRY (PHOTODENSITOMETRY), ONE OR MORE SITES $29.72 19990701 99999999 76080 RADIOLOGIC EXAMINATION, FISTULA OR SINUS TRACT STUDY $56.20 20060701 99999999 76082 COMPUTER AIDED DETECTION (COMPUTER ALGORITHM ANALYSIS OF DIGITAL IMAGE DATA FOR $15.05 20040101 99999999 76083 COMPUTER AIDED DETECTION (COMPUTER ALGORITHM ANALYSIS OF DIGITAL IMAGE DATA FOR $15.05 20040101 99999999 76085 DIGITIZATION OF FILM RADIOGRAPHIC IMAGES WITH COMPUTER ANALYSIS FOR LESION DETEC $15.38 20020101 99999999 76090 MAMMOGRAPHY $55.38 19990701 99999999 76091 MAMMOGRAPHY $68.13 19990701 99999999 76092 SCREENING MAMMOGRAPHY,BILAT.(TWO VIEW FILM STUDY EACH BREAST $48.82 19990701 99999999 76093 MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); UN $643.76 19990701 99999999 76094 MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); BI $850.70 19990701 99999999 76095 STEREOTACTIC LOCALIZATION FOR BREAST BIOPSY, EACH LESION, RADIOLOGICAL SUPERVISI $299.20 19990701 99999999 76096 LOCALIZATION OF BREAST NODULE $65.08 19990701 99999999 76098 RADIOLOGICAL EXAMINATION, BREAST SURGICAL SPECIMEN $20.56 20060701 99999999 76100 RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION (EG, TOMOGRAPHY), $64.05 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 234
PROC-CODE DESC MAC BEG END 76101 RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) $69.91 20060701 99999999 76102 RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) $80.40 20060701 99999999 76120 CINERADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED $50.43 20060701 99999999 76125 CINERADIOGRAPHY TO COMPLEMENT ROUTINE EXAMINATION $36.74 20060701 99999999 76150 XERORADIOGRAPHY $13.91 20060701 99999999 76355 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR STEREOTACTIC LOCALIZATION $319.08 19990701 99999999 76360 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR NEEDLE BIOPSY $316.83 19990701 99999999 76362 COMPUTERIZED AXIAL TOMOGRAPHIC GUIDANCE FOR, AND MONITORING OF, TISSUE ABLATION $404.63 20020101 99999999 76365 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR CYST ASPIRATION $316.83 19990701 99999999 76370 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF $130.55 19990701 99999999 76375 COMPUTERIZED TOMOGRAPHY, CORONAL, SAGITTAL, MULTIPLANAR, $149.76 19990701 99999999 76376 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC $105.59 20060701 99999999 76377 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC $132.10 20060701 99999999 76380 COMPUTERIZED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY $153.75 20060701 99999999 76390 MAGNETIC RESONANCE SPECTROSCOPY $424.53 19990701 99999999 76393 MAGNETIC RESONANCE GUIDANCE FOR NEEDLE PLACEMENT (EG, FOR BIOPSY, NEEDLE ASPIRAT $377.43 20010101 99999999 76394 MAGNETIC RESONANCE GUIDANCE FOR, AND MONITORING OF, TISSUE ABLATION $496.84 20020101 99999999 76400 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BONE MARROW $431.66 19990701 99999999 76490 ULTRASOUND GUIDANCE FOR, AND MONITORING OF, TISSUE ABLATION $122.19 20020101 99999999 76499 UNLISTED DIAGNOSTIC RADIOLOGIC PROCEDURE $66.48 19990701 99999999 76506 ECHOENCEPHALOGRAPHY, B-SCAN AND/OR REAL TIME WITH IMAGE $72.42 20060701 99999999 76510 OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN AND QUANTITATIVE A-SCAN PERFORMED $131.77 20060701 99999999 76511 OPHTHALMIC ULTRASOUND, ECHOGRAPHY $84.94 20060701 99999999 76512 OPHTHALMIC ULTRASOUND, ECHOGRAPHY $80.25 20060701 99999999 76513 OPHTHALMIC ULTRASOUND,ECHOGRAPHY IMMERSION B-SCAN $74.16 20060701 99999999 76514 OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; CORNEAL PACHYMETRY, UNILATERAL OR $9.23 20060701 99999999 76516 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, $53.24 20060701 99999999 76519 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, $56.60 20060701 99999999 76529 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION $56.34 20060701 99999999 76536 ECHOGRAPHY, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, $78.41 20060701 99999999 76604 ECHOGRAPHY, CHEST, B-SCAN (INCLUDES MEDIASTINUM) AND/OR REAL $64.82 20060701 99999999 76645 ECHOGRAPHY, BREAST(S) (UNILATERAL OR BILATERAL), $66.65 20060701 99999999 76700 ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE $96.88 20060701 99999999 76705 ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE $70.18 20060701 99999999 76770 ECHOGRAPHY, RETROPERITONEAL (EG, RENAL, AORTA, NODES), $106.53 20060701 99999999 76775 ECHOGRAPHY, RETROPERITONEAL (EG, RENAL, AORTA, NODES), $69.91 20060701 99999999 76776 ULTRASOUND, TRANSPLANTED KIDNEY, REAL TIME AND DUPLEX DOPPLER WITH IMAGE DOCUMEN $88.77 20070101 99999999 76778 ECHOGRAPHY TRANSPLANT KIDNEY,W OR W/O DUPLEX DOPPLER STUDIES $94.21 19990701 99999999 76800 ECHOGRAPHY, SPINAL CANAL AND CONTENTS $91.69 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 235
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