Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 82735 FLUORIDE $25.63 20060701 99999999 82742 FLURAZEPAM $16.60 20060701 99999999 82746 FOLIC ACID (FOLATE), BLOOD $20.32 20060701 99999999 82747 FOLIC ACID; RBC $23.93 20060701 99999999 82757 FRUCTOSE, SEMEN $14.54 20060701 99999999 82759 GALACTOKINASE, RBC $18.01 20060701 99999999 82760 GALACTOSE $15.47 20060701 99999999 82775 GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE $17.66 20060701 99999999 82776 GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE $11.59 20060701 99999999 82784 GAMMAGLOBULIN, A, D, G, M NEPHELOMETRIC, EACH $10.55 20060701 99999999 82785 GAMMAGLOBULIN, E (EG, RIA, EIA) $22.76 20060701 99999999 82787 GAMMAGLOBULIN; IMMUNOGLOBULIN SUBCLASSES, (IGG1, 2, 3, AND 4) $11.20 20060701 99999999 82800 GASES, BLOOD $11.71 20060701 99999999 82803 GASES, BLOOD $26.74 20060701 99999999 82805 GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO2 (INCLUDING CALCULATED $39.21 20060701 99999999 82810 GASES, BLOOD, O2 SATURATION ONLY, BY DIRECT MEASUREMENT, EXCEPT PULSE OXIMETRY $12.06 20060701 99999999 82820 HEMOGLOBIN-OXYGEN AFFINITY (PO2 FOR 50% HEMOGLOBIN SATURATION WITH OXYGEN) $7.80 20060701 99999999 82926 GASTRIC ACID, FREE AND TOTAL $4.57 20060701 99999999 82928 GASTRIC ACID, FREE OR TOTAL $5.49 20060701 99999999 82938 GASTRIN (SERUM) AFTER SECRETIN STIMULATION (EG, FOR $14.83 20060701 99999999 82941 GASTRIN, RIA $24.38 20060701 99999999 82943 GLUCAGON, RIA $19.75 20060701 99999999 82945 GLUCOSE, BODY FLUID, OTHER THAN BLOOD $5.42 20060701 99999999 82946 GLUCAGON TOLERANCE TEST $20.83 20060701 99999999 82947 GLUCOSE $5.42 20060701 99999999 82948 GLUCOSE $4.37 20060701 99999999 82950 GLUCOSE $6.56 20060701 99999999 82951 GLUCOSE $17.80 20060701 99999999 82952 GLUCOSE $5.42 20060701 99999999 82953 GLUCOSE $12.70 20060701 99999999 82955 GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) $13.40 20060701 99999999 82960 GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) $8.38 20060701 99999999 82962 GLUCOSE, BLOOD, BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY $2.50 20060701 99999999 82963 GLUCOSIDASE, BETA $18.01 20060701 99999999 82965 GLUTAMATE DEHYDROGENASE, BLOOD $6.48 20060701 99999999 82975 GLUTAMINE (GLUTAMIC ACID AMIDE), SPINAL FLUID $13.28 20060701 99999999 82977 GLUTAMYL TRANSPEPTIDASE, GAMMA (GGT) $9.95 20060701 99999999 82978 GLUTATHIONE $11.95 20060701 99999999 82979 GLUTATHIONE REDUCTASE, RBC $5.77 20060701 99999999 82980 GLUTETHIMIDE $15.36 20060701 99999999 82985 GLYCOPROTEIN, ELECTROPHORESIS $20.83 20060701 99999999 83001 GONADOTROPIN, PITUITARY, FOLLICLE STIMULATING HORMONE (FSH) $25.69 20060701 99999999 83002 GONADOTROPIN, PITUITARY, LUTEINIZING HORMONE (LH)(ICSH), RIA $25.60 20060701 99999999 83003 GROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN) $23.04 20060701 99999999 83008 GUANOSINE MONOPHOSPHATE (GMP), CYCLIC, RIA $14.07 20060701 99999999 83009 HELICOBACTER PYLORI, BLOOD TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE $56.47 20060701 99999999 83010 HAPTOGLOBIN $17.38 20060701 99999999 83012 HAPTOGLOBIN $14.41 20060701 99999999 83013 HELICOBACTER PYLORI, BREATH TEST ANALYSIS; $93.09 20060701 99999999 83014 HELICOBACTER PYLORI, BREATH TEST ANALYSIS; DRUG ADMINISTRATION AND SAMPLE COLLEC $10.86 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 248
PROC-CODE DESC MAC BEG END 83015 HEAVY METAL SCREEN (ARSENIC, BISMUTH, MERCURY, $19.80 20060701 99999999 83018 HEAVY METAL SCREEN (ARSENIC, BISMUTH, MERCURY, $30.35 20060701 99999999 83020 HEMOGLOBIN $17.80 20060701 99999999 83021 HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMOTOGRAPHY (EG, A2, S, C, AND/OR $24.96 20060701 99999999 83026 HEMOGLOBIN; BY COPPER SULFATE METHOD, NON-AUTOMATED $3.26 20060701 99999999 83030 HEMOGLOBIN $11.43 20060701 99999999 83033 HEMOGLOBIN $8.24 20060701 99999999 83036 HEMOGLOBIN $13.42 20060701 99999999 83045 HEMOGLOBIN $4.16 20060701 99999999 83050 HEMOGLOBIN $10.12 20060701 99999999 83051 HEMOGLOBIN $6.13 20060701 99999999 83055 HEMOGLOBIN $4.12 20060701 99999999 83060 HEMOGLOBIN $6.94 20060701 99999999 83065 HEMOGLOBIN $5.77 20060701 99999999 83068 HEMOGLOBIN $7.10 20060701 99999999 83069 HEMOGLOBIN $3.31 20060701 99999999 83070 HEMOSIDERIN, URINE $6.56 20060701 99999999 83071 HEMOSIDERIN, RIA $5.77 20060701 99999999 83080 B-HEXOSAMINIDASE, EACH ASSAY $23.31 20060701 99999999 83088 HISTAMINE $40.81 20060701 99999999 83090 HOMOCYSTINE $23.31 20060701 99999999 83150 HOMOVANILLIC ACID (HVA), URINE $19.80 20060701 99999999 83491 HYDROXYCORTICOSTEROIDS, 17- (17-OHCS) $14.68 20060701 99999999 83497 HYDROXYINDOLACETIC ACID, 5-(HIAA), URINE $17.82 20060701 99999999 83498 HYDROXYPROGESTERONE, 17-D, RIA $37.54 20060701 99999999 83499 HYDROXYPROGESTERONE, 20- $21.13 20060701 99999999 83500 HYDROXYPROLINE, URINE $18.99 20060701 99999999 83505 HYDROXYPROLINE, URINE $20.38 20060701 99999999 83516 IMMUNOASSAY FOR ANALYTE OTHER THAN ANTIBODY OR INFECTIOUS AGENT ANTIGEN, QUALITA $15.95 20060701 99999999 83518 IMMUNOASSAY, FOR ANALYTE OTHER THAN ANTIBODY, QUALITATIVE OR SEMIQUANTITATIVE $11.72 20060701 99999999 83519 IMMUNOASSAY, ANALYTE; BY RADIONUCLIDE TECHNIQUE (EG, RIA) $18.67 20060701 99999999 83520 IMMUNOASSAY, ANALYTE; NOT OTHERWISE SPECIFIED $17.89 20060701 99999999 83525 INSULIN, RIA $15.81 20060701 99999999 83527 INSULIN; FREE $10.85 20060701 99999999 83528 INTRINSIC FACTOR LEVEL $13.33 20060701 99999999 83540 IRON, SERUM $8.95 20060701 99999999 83550 IRON BINDING CAPACITY, SERUM $12.08 20060701 99999999 83570 ISOCITRIC DEHYDROGENASE (IDH), BLOOD $7.42 20060701 99999999 83582 KETOGENIC STEROIDS, URINE $11.88 20060701 99999999 83586 KETOSTEROIDS, 17- (17-KS), BLOOD $10.73 20060701 99999999 83593 KETOSTEROIDS, 17- (17-KS), URINE $22.05 20060701 99999999 83605 LACTATE (LACTIC ACID) $14.76 20060701 99999999 83615 LACTIC DEHYDROGENASE (LDH), BLOOD $8.35 20060701 99999999 83625 LACTIC DEHYDROGENASE (LDH), BLOOD $10.73 20060701 99999999 83630 LACTOFERRIN, FECAL, QUALITATIVE $16.45 20060701 99999999 83631 LACTIC DEHYDROGENASE (LDH), CSF $16.45 20060701 99999999 83632 LACTOGEN, HUMAN PLACENTAL (HPL) CHORIONIC SOMATOMAMMOTROPIN, $16.94 20060701 99999999 83633 LACTOSE, URINE $4.61 20060701 99999999 83634 LACTOSE, URINE $9.66 20060701 99999999 83655 LEAD, QUANTITATIVE $16.72 20060701 99999999 83661 LECITHIN-SPHINGOMYELIN RATIO (L/S RATIO), AMNIOTIC FLUID $18.43 20060701 99999999 83662 LECITHIN-SPHINGOMYELIN RATIO (L/S RATIO); FOAM STABILITY TEST $15.86 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 249
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