Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 87046 CULTURE, BACTERIAL; STOOL, ADDITIONAL PATHOGENS, ISOLATION AND PRELIMINARY EXAMI $7.91 20060701 99999999 87060 CULTURE, BACTERIAL, DEFINITIVE $10.67 19990701 99999999 87070 CULTURE, BACTERIAL, DEFINITIVE $11.90 20060701 99999999 87071 CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIF $7.91 20060701 99999999 87072 CULTURE OR DIRECT BACTERIAL IDENTIFICATION METHOD, EACH $11.16 19990701 99999999 87073 CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENT $7.91 20060701 99999999 87075 CULTURE, BACTERIAL, ANY SOURCE $13.08 20060701 99999999 87076 CULTURE, BACTERIAL, ANY SOURCE $11.16 20060701 99999999 87077 CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE $11.16 20060701 99999999 87081 CULTURE, BACTERIAL, SCREENING ONLY, FOR SINGLE $9.16 20060701 99999999 87084 CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY, BY $11.90 20060701 99999999 87085 CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY, BY $11.90 19990701 99999999 87086 CULTURE, BACTERIAL, URINE $11.16 20060701 99999999 87088 CULTURE, BACTERIAL, URINE $10.55 20060701 99999999 87101 CULTURE, FUNGI, ISOLATION $10.66 20060701 99999999 87102 CULTURE, FUNGI, ISOLATION $11.61 20060701 99999999 87103 CULTURE, FUNGI, ISOLATION BLOOD $12.46 20060701 99999999 87106 CULTURE, FUNGI, DEFINITIVE IDENTIFICATION OF EACH FUNGUS $14.27 20060701 99999999 87107 CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; MOLD $14.42 20060701 99999999 87109 CULTURE, MYCOPLASMA, ANY SOURCE $21.26 20060701 99999999 87110 CULTURE, CHLAMYDIA $27.08 20060701 99999999 87116 CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, $13.63 20060701 99999999 87117 CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, $15.99 19990701 99999999 87118 CULTURE, MYCOBACTERIA, DEFINITIVE IDENTIFICATION OF EACH ORGANISM $15.13 20060701 99999999 87140 CULTURE, TYPING $7.71 20060701 99999999 87143 CULTURE, TYPING $10.51 20060701 99999999 87147 CULTURE, TYPING $7.15 20060701 99999999 87149 CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID PROBE $27.71 20060701 99999999 87152 CULTURE, TYPING; IDENTIFICATION BY PULSE FIELD GEL TYPING $4.39 20060701 99999999 87158 CULTURE, TYPING $4.39 20060701 99999999 87163 CULTURE, ANY SOURCE, ADDITIONAL IDENTIFICATION METHODS REQUIRED $15.30 19990701 99999999 87164 DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, $9.01 20060701 99999999 87166 DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, $9.47 20060701 99999999 87168 MACROSCOPIC EXAMINATION; ARTHROPOD $5.40 20060701 99999999 87169 MACROSCOPIC EXAMINATION; PARASITE $5.90 20060701 99999999 87172 PINWORM EXAM (EG, CELLOPHANE TAPE PREP) $5.90 20060701 99999999 87176 ENDOTOXIN, BACTERIAL (PYROGENS) $4.93 20060701 99999999 87177 OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION $12.30 20060701 99999999 87181 SENSITIVITY STUDIES, ANTIBIOTIC $2.57 20060701 99999999 87184 SENSITIVITY STUDIES, ANTIBIOTIC $9.53 20060701 99999999 87185 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYME DETECTION (EG, BETA LACTAMAS $2.57 20060701 99999999 87186 SENSITIVITY STUDIES, ANTIBIOTIC $11.94 20060701 99999999 87187 SENSITIVITY STUDIES,ANTIBIOTIC MBC(USE IN ADDIT.87186-87188) $8.69 20060701 99999999 87188 SENSITIVITY STUDIES, ANTIBIOTIC $5.56 20060701 99999999 87190 SENSITIVITY STUDIES, ANTIBIOTIC $7.81 20060701 99999999 87197 SERUM BACTERICIDAL TITER (SCHLICTER TEST) $9.79 20060701 99999999 87205 SMEAR, PRIMARY SOURCE, WITH INTERPRETATION $5.90 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 260
PROC-CODE DESC MAC BEG END 87206 SMEAR, PRIMARY SOURCE, WITH INTERPRETATION $7.42 20060701 99999999 87207 SMEAR, PRIMARY SOURCE, WITH INTERPRETATION $8.37 20060701 99999999 87209 SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN (EG, TRICHROME, $17.57 20060701 99999999 87210 SMEAR, PRIMARY SOURCE, WITH INTERPRETATION $5.90 20060701 99999999 87220 TISSUE EXAMINATION FOR FUNGI (EG, KOH SLIDE) $5.90 20060701 99999999 87230 TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUM $27.28 20060701 99999999 87250 VIRUS IDENTIFICATION $27.02 20060701 99999999 87252 VIRUS IDENTIFICATION $36.02 20060701 99999999 87253 VIRUS IDENTIFICATION TISSUE CULTURE,ADDITIONAL STUDIES_ISOLA $12.39 20060701 99999999 87254 VIRUS ISOLATION; SHELL VIAL, INCLUDES IDENTIFICATION WITH IMMUNOFLUORESCENCE STA $16.39 20060701 99999999 87255 VIRUS ISOLATION; INCLUDING IDENTIFICATION BY NON-IMMUNOLOGIC METHOD, OTHER THAN $42.92 20060701 99999999 87260 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; ADE $10.06 20060701 99999999 87265 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; BOR $16.58 20060701 99999999 87267 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ENTEROVIRUS, $16.76 20060701 99999999 87269 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; GIARDIA $12.02 20060701 99999999 87270 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; CHL $16.58 20060701 99999999 87271 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CYTOMEGALOVIR $16.76 20060701 99999999 87272 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; CRY $16.58 20060701 99999999 87273 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLE $10.06 20060701 99999999 87274 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; HER $16.58 20060701 99999999 87275 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B V $16.58 20060701 99999999 87276 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; INF $16.58 20060701 99999999 87277 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; LEGIONELLA MI $10.06 20060701 99999999 87278 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; LEG $16.58 20060701 99999999 87279 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PARAINFLUENZA $10.06 20060701 99999999 87280 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; RES $16.58 20060701 99999999 87281 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCYSTIS $10.06 20060701 99999999 87283 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RUBEOLA $10.06 20060701 99999999 87285 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; TRE $10.06 20060701 99999999 87290 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; VAR $10.06 20060701 99999999 87299 INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE, NOT $16.58 20060701 99999999 87300 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT FO $10.06 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 261
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