Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 87901 INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA), HIV 1, REVERSE $355.78 20060701 99999999 87902 INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C VIR $256.16 20060701 99999999 87903 INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESIS $486.21 20060701 99999999 87904 INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESIS $35.94 20060701 99999999 87999 UNLISTED MICROBIOLOGY PROCEDURE $7.90 19990701 99999999 88104 CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, WITH $35.00 20060701 99999999 88106 CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, WITH $47.63 20060701 99999999 88107 CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, WITH $64.69 20060701 99999999 88108 CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, WITH $44.09 20060701 99999999 88112 CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION (EG, $93.30 20060701 99999999 88125 CYTOPATHOLOGY, FORENSIC (EG, SPERM) $13.13 20060701 99999999 88130 SEX CHROMATIN IDENTIFICATION $12.61 20060701 99999999 88140 SEX CHROMATIN IDENTIFICATION $11.05 20060701 99999999 88141 CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM); REQUIRING INTERPRETAT $22.89 20060701 99999999 88142 CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVA $28.00 20060701 99999999 88143 CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVA $16.99 20060701 99999999 88147 CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM UNDER P $15.73 20060701 99999999 88148 CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM WITH MA $21.00 20060701 99999999 88150 CYTOPATHOLOGY, SMEARS, CERVICAL OR VAGINAL $14.60 20060701 99999999 88152 CYTOPATHOLOGY, SMEARS, CERVICAL OR VAGINAL, UP TO THREE SMEARS; WITH MANUAL CYTO $8.86 20060701 99999999 88153 CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND RESCREENIN $8.86 20060701 99999999 88154 CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND COMPUTER-A $14.60 20060701 99999999 88155 CYTOPATHOLOGY, SMEARS, CERVICAL OR VAGINAL $7.59 20060701 99999999 88160 CYTOPATHOLOGY, ANY OTHER SOURCE $33.12 20060701 99999999 88161 CYTOPATHOLOGY, ANY OTHER SOURCE $35.90 20060701 99999999 88162 CYTOPATHOLOGY, ANY OTHER SOURCE $44.05 20060701 99999999 88164 CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); MANUAL SCREENI $14.60 20060701 99999999 88165 CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SC $14.60 20060701 99999999 88166 CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SC $8.86 20060701 99999999 88167 CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SC $8.86 20060701 99999999 88170 FINE NEEDLE ASPIRATION WITH OR WITHOUT PREPARATION OF $51.02 19990701 99999999 88171 FINE NEEDLE ASPIRATION WITH OR WITHOUT PREPARATION OF $87.34 19990701 99999999 88172 EVALUATION OF FINE NEEDLE ASPIRATE WITH OR WITHOUT $39.40 20060701 99999999 88173 EVALUATION OF FINE NEEDLE ASPIRATE WITH OR WITHOUT $87.10 20060701 99999999 88174 CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVA $29.85 20060701 99999999 88175 CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVA $37.01 20060701 99999999 88180 FLOW CYTOMETRY $20.97 20021101 99999999 88182 FLOW CYTOMETRY $68.89 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 266
PROC-CODE DESC MAC BEG END 88184 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL $40.70 20060701 99999999 88185 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL $19.96 20060701 99999999 88187 FLOW CYTOMETRY, INTERPRETATION; 2 TO 8 MARKERS $51.09 20060701 99999999 88188 FLOW CYTOMETRY, INTERPRETATION; 9 TO 15 MARKERS $63.76 20060701 99999999 88189 FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS $84.00 20060701 99999999 88199 UNLISTED CYTOPATHOLOGY PROCEDURE $15.32 19990701 99999999 88230 TISSUE CULTURE FOR CHROMOSOME ANALYSIS LYMPHOCYTE $161.00 20060701 99999999 88233 TISSUE CULT. FOR CHROMOSOME ANALYSIS SKIN OR OTHER SOL. TISS $117.98 20060701 99999999 88235 TISSUE CULTURE FOR CHROMOSOME ANALYSIS $146.52 20060701 99999999 88237 TISSUE CULTURE FOR CHROMOSOME ANALYSIS BONE MARROW CELLS $125.68 20060701 99999999 88239 TISSUE CULTURE FOR CHROMOSOME ANALYSIS OTHER TISSUE $123.67 20060701 99999999 88240 CRYOPRESERVATION, FREEZING AND STORAGE OF CELLS, EACH CELL LINE $3.76 20060701 99999999 88241 THAWING AND EXPANSION OF FROZEN CELLS, EACH ALIQUOT $3.76 20060701 99999999 88245 CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES SCORE 25 CELLS $95.85 20060701 99999999 88248 CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES SCORE 100 CELLS $145.18 20060701 99999999 88249 CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 100 CELLS, CLASTOGEN STRESS (E $145.18 20060701 99999999 88261 CHROMOSOME ANALYSIS $148.16 20060701 99999999 88262 CHROMOSOME ANALYSIS $124.02 20060701 99999999 88263 CHROMOSOME ANALYSIS COUNT 45 CELLS FOR MOSAICISM,2 KARYOTYYP $125.98 20060701 99999999 88264 CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS $104.48 20060701 99999999 88267 CHROMOSOME ANALYSIS, AMNIOTIC FLUID OR CHORIONIC VILLUS, $178.88 20060701 99999999 88269 CHROMOSOME ANALYSIS, IN SITU FOR AMNIOTIC FLUID CELLS, COUNT $139.43 20060701 99999999 88271 MOLECULAR CYTOGENETICS; DNA PROBE, EACH (EG, FISH) $29.60 20060701 99999999 88272 MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 3-5 CELLS (EG $22.45 20060701 99999999 88273 MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 10-30 CELLS ( $44.40 20060701 99999999 88274 MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 25-99 CELLS $29.18 20060701 99999999 88275 MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 100-300 CELLS $55.50 20060701 99999999 88280 CHROMOSOME ANALYSIS $34.68 20060701 99999999 88283 CHROMOSOME ANALYSIS ADDITIONAL SPECIALIZED BANDING TECHNIQUE $28.43 20060701 99999999 88285 CHROMOSOME ANALYSIS $15.92 20060701 99999999 88289 CHROMOSOME ANALYSIS ADDITIONAL HIGH RESOLUTION STUDY $13.11 20060701 99999999 88291 CYTOGENETICS AND MOLECULAR CYTOGENETICS, INTERPRETATION AND REPORT $16.54 20060701 99999999 88300 SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY $13.56 20060701 99999999 88302 SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION $29.54 20060701 99999999 88304 SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION $38.92 20060701 99999999 88305 SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION $66.67 20060701 99999999 88307 SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION $118.35 20060701 99999999 88309 SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION $165.80 20060701 99999999 88311 DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION $12.61 20060701 99999999 88312 SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR $51.28 20060701 99999999 88313 SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR $37.43 20060701 99999999 88314 SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR $63.31 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 267
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Medicaid Fee Schedule without Mods 200801

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