Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 83663 FETAL LUNG MATURITY ASSESSMENT; FLUORESCENCE POLARIZATION $26.43 20060701 99999999 83664 FETAL LUNG MATURITY ASSESSMENT; LAMELLAR BODY DENSITY $26.43 20060701 99999999 83670 LEUCINE AMINOPEPTIDASE (LAP), BLOOD $7.68 20060701 99999999 83690 LIPASE, BLOOD $9.52 20060701 99999999 83695 LIPOPROTEIN (A) $12.66 20060701 99999999 83698 LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2, (LP-PLA2) $47.43 20070101 99999999 83700 LIPIDS, BLOOD $9.44 20060701 99999999 83701 LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION AND QUANTITATION OF LIPOPROTEI $24.28 20060701 99999999 83704 LIPOPROTEIN, BLOOD; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBERS AND LIPOPROTEIN $30.86 20060701 99999999 83715 LIPOPROTEIN, BLOOD $15.56 19990701 99999999 83718 LIPOPROTEIN HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) $11.31 20060701 99999999 83719 LIPOPROTEIN VERY LOW DENSITY CHOLESTEROL (VLDL CHOLESTEROL) $9.76 20060701 99999999 83721 LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL $13.18 20060701 99999999 83727 LUTEINIZING RELEASING FACTOR (LRH), RIA $14.41 20060701 99999999 83735 MAGNESIUM, BLOOD $9.26 20060701 99999999 83775 MALATE DEHYDROGENASE, KINETIC ULTRAVIOLET METHOD $6.18 20060701 99999999 83785 MANGANESE, BLOOD OR URINE $20.62 20060701 99999999 83788 MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/ MS), ANALYTE NOT ELSEWHE $24.96 20060701 99999999 83789 MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/ MS), ANALYTE NOT ELSEWHE $24.96 20060701 99999999 83805 MEPROBAMATE, BLOOD OR URINE $24.36 20060701 99999999 83825 MERCURY, QUANTITATIVE $22.47 20060701 99999999 83835 METANEPHRINES, URINE $23.41 20060701 99999999 83840 METHADONE $22.56 20060701 99999999 83857 METHEMALBUMIN $14.84 20060701 99999999 83858 METHSUXIMIDE, SERUM $12.43 20060701 99999999 83864 MUCOPOLYSACCHARIDES, ACID, BLOOD $16.69 20060701 99999999 83866 MUCOPOLYSACCHARIDES, ACID, URINE $8.26 20060701 99999999 83872 MUCIN, SYNOVIAL FLUID (ROPES TEST) $8.10 20060701 99999999 83873 MYELIN BASIC PROTEIN, CSF, RIA $14.42 20060701 99999999 83874 MYOGLOBIN, ELECTROPHORESIS $17.84 20060701 99999999 83880 NALORPHINE $28.46 20060701 99999999 83883 NEPHELOMETRY, EACH ANALYTE NOT ELSEWHERE SPECIFIED $18.79 20060701 99999999 83885 NICKEL, URINE $20.54 20060701 99999999 83887 NICOTINE $19.85 20060701 99999999 83890 NUCLEAR MOLECULAR DIAGNOSTICS; MOLECULAR ISOLATION OR EXTRACTION $5.54 20060701 99999999 83891 MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIED NUCLEIC ACID $5.54 20060701 99999999 83892 NUCLEAR MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION $5.54 20060701 99999999 83893 MOLECULAR DIAGNOSTICS; DOT/SLOT BLOT PRODUCTION $5.54 20060701 99999999 83894 NUCLEAR MOLECULAR DIAGNOSTICS; SEPARATION (EG, DOT BLOT, ELECTROPHORESIS) $5.54 20060701 99999999 83896 NUCLEAR MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH $5.54 20060701 99999999 83897 MOLECULAR DIAGNOSTICS; NUCLEIC ACID TRANSFER (EG, SOUTHERN, NORTHERN) $5.54 20060701 99999999 83898 NUCLEAR MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE WITH AMPLIFICATION, EG, POLYME $23.17 20060701 99999999 83900 NITROGEN, TOTAL $28.10 20060701 99999999 83901 MOLECULAR DIAGNOSTICS; AMPLIFICATION OF PATIENT NUCLEIC ACID, MULTIPLEX, EACH MU $23.17 20060701 99999999 83902 MOLECULAR DIAGNOSTICS AMPLIFICATION EG POLYMERASE CHAIN REACTION (PCR) REVERSE T $19.61 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 250
PROC-CODE DESC MAC BEG END 83903 MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG, SINGLE STR $23.17 20060701 99999999 83904 MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY SEQUENCING, SINGLE SEGMENT, EA $23.17 20060701 99999999 83905 MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY ALLELE SPECIFIC TRANSCRIPTION, $14.05 20060701 99999999 83906 MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY ALLELE SPECIFIC TRANSLATION, S $14.05 20060701 99999999 83907 MOLECULAR DIAGNOSTICS; LYSIS OF CELLS PRIOR TO NUCLEIC ACID EXTRACTION (EG, STOO $13.06 20060701 99999999 83908 MOLECULAR DIAGNOSTICS; SIGNAL AMPLIFICATION OF PATIENT NUCLEIC ACID, EACH NUCLEI $16.39 20060701 99999999 83909 MOLECULAR DIAGNOSTICS; SEPARATION AND IDENTIFICATION BY HIGH RESOLUTION TECHNIQU $16.39 20060701 99999999 83912 NUCLEIC ACID PROBE, WITH ELECTROPHORESIS W/EXAM & REPORT $5.60 20060701 99999999 83914 MUTATION IDENTIFICATION BY ENZYMATIC LIGATION OR PRIMER EXTENSION, SINGLE SEGMEN $16.39 20060701 99999999 83915 NUCLEOTIDASE 5'- $9.35 20060701 99999999 83916 OLIGOCLONAL IMMUNE GLOBULIN (IG), CSF, BY ELECTROPHORESIS $27.79 20060701 99999999 83918 ORGANIC ACIDS $22.75 20060701 99999999 83919 ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN $22.75 20060701 99999999 83921 ORGANIC ACID, SINGLE, QUANTITATIVE $22.75 20060701 99999999 83925 OPIATES, (EG, MORPHINE, MEPERIDINE) $26.89 20060701 99999999 83930 OSMOLALITY $9.13 20060701 99999999 83935 OSMOLALITY $9.42 20060701 99999999 83937 OSTEOCALCIN (BONE G1A PROTEIN) $41.26 20060701 99999999 83945 OXALATE, URINE $17.80 20060701 99999999 83950 ONCOPROTEIN, HER-2/NEU $53.99 20060701 99999999 83970 PARATHORMONE (PARATHYROID HORMONE), RIA $57.04 20060701 99999999 83986 PH, BODY FLUID, EXCEPT BLOOD $4.95 20060701 99999999 83992 PHENCYCLIDINE (PCP) $12.32 20060701 99999999 83993 CALPROTECTIN, FECAL $27.42 20080101 99999999 84022 PHENOTHIAZINE, URINE $13.06 20060701 99999999 84030 PHENYLALANINE (PKU), BLOOD $7.61 20060701 99999999 84035 PHENYLKETONES $3.07 20060701 99999999 84060 PHOSPHATASE, ACID $6.19 20060701 99999999 84061 PHOSPHATASE, ACID; FORENSIC EXAMINATION $6.64 20060701 99999999 84066 PHOSPHATASE, ACID $13.35 20060701 99999999 84075 PHOSPHATASE, ALKALINE, BLOOD $7.15 20060701 99999999 84078 PHOSPHATASE, ALKALINE, BLOOD $6.12 20060701 99999999 84080 PHOSPHATASE, ALKALINE, BLOOD $20.44 20060701 99999999 84081 PHOSPHATYDYLGLYCEROL $22.84 20060701 99999999 84085 PHOSPHOGLUCONATE, 6-, DEHYDROGENASE, RBC $5.65 20060701 99999999 84087 PHOSPHOHEXOSE ISOMERASE $8.65 20060701 99999999 84100 PHOSPHORUS (PHOSPHATE) $6.56 20060701 99999999 84105 PHOSPHORUS (PHOSPHATE) $7.15 20060701 99999999 84106 PORPHOBILINOGEN, URINE $3.59 20060701 99999999 84110 PORPHOBILINOGEN, URINE $11.68 20060701 99999999 84119 PORPHYRINS, COPRO-, URINE $11.90 20060701 99999999 84120 PORPHYRINS $20.33 20060701 99999999 84126 PORPHYRINS, FECES, QUANTITATIVE $21.35 20060701 99999999 84127 PORPHYRINS, FECES; QUALITATIVE $9.77 20060701 99999999 84132 POTASSIUM $6.35 20060701 99999999 84133 POTASSIUM $5.94 20060701 99999999 84134 PREALBUMIN $20.16 20060701 99999999 84135 PREGNANEDIOL $16.04 20060701 99999999 84138 PREGNANETRIOL $15.88 20060701 99999999 84140 PREGNENOLONE $28.58 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 251
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