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 />
78585 PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION $228.33 20060701 99999999<br />
78586 PULMONARY VENTILATION IMAGING, AEROSOL $101.37 20060701 99999999<br />
78587 PULMONARY VENTILATION IMAGING, AEROSOL $111.53 20060701 99999999<br />
78588<br />
PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION<br />
IMAGING, AEROSOL, ONE $184.94 20060701 99999999<br />
78591 PULMONARY VENTILATION IMAGING, GASEOUS, $109.70 20060701 99999999<br />
78593 PULMONARY VENTILATION IMAGING, GASEOUS, WITH $132.87 20060701 99999999<br />
78594 PULMONARY VENTILATION IMAGING, GASEOUS, WITH $184.95 20060701 99999999<br />
78596<br />
PULMONARY QUANTITATIVE DIFFERENTIAL FUNCTION<br />
(VENTILATION/PERFUSION) STUDY $282.85 20060701 99999999<br />
78600 BRAIN IMAGING, LIMITED PROCEDURE $112.40 20060701 99999999<br />
78601 BRAIN IMAGING, LIMITED PROCEDURE $132.15 20060701 99999999<br />
78605 BRAIN IMAGING, COMPLETE STUDY $133.29 20060701 99999999<br />
78606 BRAIN IMAGING, COMPLETE STUDY $152.60 20060701 99999999<br />
78607 BRAIN IMAGING,COMPLETE STUDY TOMOGRAPHIC(ECT) $264.77 20060701 99999999<br />
78608<br />
BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET);<br />
METABOLIC EVALUATION $1,495.20 19940101 99999999<br />
78610 BRAIN IMAGING, VASCULAR FLOW ONLY $64.11 20060701 99999999<br />
78615 CEREBRAL BLOOD FLOW $144.00 19990701 99999999<br />
78630<br />
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING<br />
INTRODUCTION $193.15 20060701 99999999<br />
78635<br />
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING<br />
INTRODUCTION $109.38 20060701 99999999<br />
78645<br />
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING<br />
INTRODUCTION $135.28 20060701 99999999<br />
78647<br />
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING<br />
INTRODUCTION OF MATERIAL); TOMO $230.19 20060701 99999999<br />
78650<br />
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING<br />
INTRODUCTION $176.82 20060701 99999999<br />
78660 DACRYOCYSTOGRAPHY (LACRIMAL FLOW STUDY) $90.87 20060701 99999999<br />
78700 KIDNEY IMAGING $117.90 20060701 99999999<br />
78701 KIDNEY IMAGING $136.30 20060701 99999999<br />
78704 KIDNEY IMAGING $159.47 19990701 99999999<br />
78707 KIDNEY IMAGING $185.04 20060701 99999999<br />
78708<br />
KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; SINGLE<br />
STUDY, WITH PHARMACOLOGIC $192.80 20060701 99999999<br />
78709<br />
KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; MULTIPLE<br />
STUDIES, WITH AND WITHO $199.00 20060701 99999999<br />
78710 KIDNEY IMAGING(SPECT) $221.07 20060701 99999999<br />
78715 KIDNEY VASCULAR FLOW ONLY $64.42 19990701 99999999<br />
78725 KIDNEY FUNCTION STUDY ONLY $73.95 20060701 99999999<br />
78730 URINARY BLADDER RESIDUAL STUDY $62.88 20060701 99999999<br />
78740 URETERAL REFLUX STUDY (RADIONUCLIDE VOIDING CYSTOGRAM) $92.24 20060701 99999999<br />
78760 TESTICULAR IMAGING $114.39 19990701 99999999<br />
78761 TESTICULAR IMAGING $133.67 20060701 99999999<br />
78800 RADIONUCLIDE LOCALIZATION OF TUMOR $152.44 20060701 99999999<br />
78801 RADIONUCLIDE LOCALIZATION OF TUMOR $170.40 20060701 99999999<br />
78802 RADIONUCLIDE LOCALIZATION OF TUMOR $216.41 20060701 99999999<br />
78803 TUMOR LOCALIZATION (SPECT) $259.27 20060701 99999999<br />
78804<br />
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION<br />
OF RADIOPHARMACEUTICAL $320.14 20060701 99999999<br />
78805 RADIONUCLIDE LOCALIZATION OF ABSCESS $140.99 20060701 99999999<br />
78806 RADIONUCLIDE LOCALIZATION OF ABSCESS $252.31 20060701 99999999<br />
78807 RADIONUCLIDE LOCALIZATION OF ABSCESS, SPECT $258.96 20060701 99999999<br />
78810<br />
TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET),<br />
METABOLIC EVALUATION $1,495.20 19960101 99999999<br />
78990 PROVISION OF DIAGNOSTIC RADIONUCLIDE(S) $10.92 19990701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 242