Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 88318 DETERMINATIVE HISTOCHEMISTRY TO IDENTIFY CHEMICAL $51.83 20060701 99999999 88319 DETERMINATIVE HISTOCHEMISTRY OR CYTOCHEMISTRY TO IDENTIFY $99.23 20060701 99999999 88321 CONSULTATION AND REPORT ON REFERRED SLIDES PREPARED ELSEWHERE $70.99 20060701 99999999 88323 CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING $85.05 20060701 99999999 88325 CONSULTATION, COMPREHENSIVE, WITH REVIEW OF RECORDS AND $106.09 20060701 99999999 88329 CONSULTATION DURING SURGERY $37.40 20060701 99999999 88331 CONSULTATION DURING SURGERY $61.43 20060701 99999999 88332 CONSULTATION DURING SURGERY $26.58 20060701 99999999 88333 PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQ $62.55 20060701 99999999 88334 PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQ $32.70 20060701 99999999 88342 IMMUNOCYTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE), $57.22 20060701 99999999 88346 IMMUNOFLUORESCENT STUDY, EACH ANTIBODY $60.22 20060701 99999999 88347 IMMUNOFLUORESCENT STUDY, EACH ANTIBODY INDIRECT METHOD $61.12 20060701 99999999 88348 ELECTRON MICROSCOPY $273.83 20060701 99999999 88349 ELECTRON MICROSCOPY $109.19 20060701 99999999 88355 MORPHOMETRIC ANALYSIS $266.70 20060701 99999999 88356 MORPHOMETRIC ANALYSIS $178.32 20060701 99999999 88358 MORPHOMETRIC ANALYSIS TUMOR $46.95 20060701 99999999 88360 WHOLE ORGAN SECTIONS FOR SPECIAL STUDIES $84.56 20060701 99999999 88361 MORPHOMETRIC ANALYSIS; TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN RECEP $107.70 20060701 99999999 88362 NERVE TEASING PREPARATION $171.05 20060701 99999999 88365 TISSUE IN SITU HYBRIDIZATION,INTERPRETATION AND REPORT $82.14 20060701 99999999 88367 MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR $163.50 20060701 99999999 88368 MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR $94.81 20060701 99999999 88371 PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT; $18.63 20060701 99999999 88372 PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT; IMMU $19.07 20060701 99999999 88381 MICRODISSECTION (IE, SAMPLE PREPARATION OF MICROSCOPICALLY IDENTIFIED TARGET); M $126.26 20080101 99999999 88385 ARRAY-BASED EVALUATION OF MULTIPLE MOLECULAR PROBES; 51 THROUGH 250 PROBES $215.83 20060701 99999999 88386 ARRAY-BASED EVALUATION OF MULTIPLE MOLECULAR PROBES; 251 THROUGH 500 PROBES $223.97 20060701 99999999 88399 UNLISTED SURGICAL PATHOLOGY PROCEDURE $22.00 19990701 99999999 88400 BILIRUBIN, TOTAL, TRANSCUTANEOUS $4.21 20060701 99999999 89049 CAFFEINE HALOTHANE CONTRACTURE TEST (CHCT) FOR MALIGNANT HYPERTHERMIA SUSCEPTIBI $44.44 20060701 99999999 89050 CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CSF, $6.53 20060701 99999999 89051 CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CSF, $7.61 20060701 99999999 89055 LEUKOCYTE COUNT, FECAL $5.96 20060701 99999999 89060 CRYSTAL IDENTIFICATION BY COMPENSATED POLARIZING LENS $9.88 20060701 99999999 89100 DUODENAL INTUBATION AND ASPIRATION $31.62 20060701 99999999 89105 DUODENAL INTUBATION AND ASPIRATION $25.97 20060701 99999999 89125 FAT STAIN, FECES, URINE, OR SPUTUM $5.96 20060701 99999999 89130 GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH $22.13 20060701 99999999 89132 GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH $9.19 20060701 99999999 89135 GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS $39.59 20060701 99999999 89136 GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS $11.14 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 268
PROC-CODE DESC MAC BEG END 89140 GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS $42.56 20060701 99999999 89141 GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS $46.57 20060701 99999999 89160 MEAT FIBERS, FECES $5.09 20060701 99999999 89190 NASAL SMEAR FOR EOSINOPHILS $6.56 20060701 99999999 89220 SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE) $11.23 20060701 99999999 89225 STARCH GRANULES, FECES $3.36 20060701 99999999 89230 SWEAT COLLECTION BY IONTOPHORESIS $3.14 20060701 99999999 89235 WATER LOAD TEST $4.61 20060701 99999999 89240 UNLISTED MISCELLANEOUS PATHOLOGY TEST $10.50 20040101 99999999 89300 SEMEN ANALYSIS $12.32 20060701 99999999 89310 SEMEN ANALYSIS $7.22 20060701 99999999 89320 SEMEN ANALYSIS $16.66 20060701 99999999 89321 SEMEN ANALYSIS, PRESENCE AND/OR MOTILITY OF SPERM $16.66 20060701 99999999 89322 SEMEN ANALYSIS; VOLUME, COUNT, MOTILITY, AND DIFFERENTIAL USING STRICT MORPHOLOG $21.65 20080101 99999999 89325 SPERM ANTIBODIES $8.95 20060701 99999999 89329 SPERM EVALUATION $17.58 20060701 99999999 89330 SPERM EVALUATION $8.30 20060701 99999999 89331 SPERM EVALUATION, FOR RETROGRADE EJACULATION, URINE (SPERM CONCENTRATION, MOTILI $27.37 20080101 99999999 89360 SWEAT COLLECTION BY IONTOPHORESIS $16.49 19990701 99999999 89399 UNLISTED MISCELLANEOUS PATHOLOGY TEST $14.11 19990701 99999999 90050 OFFICE MEDICAL SERVICE, ESTABLISHED PATIENT $48.18 19990701 99999999 90060 OFFICE MEDICAL SERVICE, ESTABLISHED PATIENT $48.18 19990701 99999999 90384 RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, FULL-DOSE, FOR INTRAMUSCULAR USE $4.00 19990701 99999999 90471 IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, I $4.00 19990701 99999999 90472 IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, I $4.00 19990701 99999999 90476 ADENOVIRUS VACCINE, TYPE 4, LIVE, FOR ORAL USE $4.00 20010101 99999999 90477 ADENOVIRUS VACCINE, TYPE 7, LIVE, FOR ORAL USE $4.00 20010101 99999999 90581 ANTHRAX VACCINE, FOR SUBCUTANEOUS USE $4.00 20010101 99999999 90585 BACILLUS CALMETTE-GUERIN VACCINE (BCG) FOR TUBERCULOSIS, LIVE, FOR PERCUTANEOUS $4.00 20010101 99999999 90586 BACILLUS CALMETTE-GUERIN VACCINE (BCG) FOR BLADDER CANCER, LIVE, FOR INTRAVESICA $4.00 20010101 99999999 90632 HEPATITIS A VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE $4.00 19990701 99999999 90633 HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT DOSAGE-2 DOSE SCHEDULE, FOR INTRAMUSCU $4.00 19990701 99999999 90634 HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT DOSAGE-3 DOSE SCHEDULE, FOR INTRAMUSCU $4.00 19990701 99999999 90636 HEPATITIS A AND HEPATITIS B VACCINE (HEPA-HEPB), ADULT DOSAGE, FOR INTRAMUSCULAR $4.00 19990701 99999999 90645 HEMOPHILUS INFLUENZA B VACCINE (HIB), HBOC CONJUGATE (4 DOSE SCHEDULE), FOR INTR $4.00 19990701 99999999 90646 HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-D CONJUGATE, FOR BOOSTER USE ONLY, INT $4.00 20010101 99999999 90647 HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-OMP CONJUGATE (3 DOSE SCHEDULE), FOR I $4.00 19990701 99999999 90648 HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-T CONJUGATE (4 DOSE SCHEDULE), FOR INT $4.00 19990701 99999999 90649 HUMAN PAPILLOMA VIRUS (HPV) VACCINE, TYPES 6, 11, 16, 18 (QUADRIVALENT), 3 DOSE $4.00 20060101 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 269
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Medicaid Fee Schedule without Mods 200801

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