Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 92532 POSITIONAL NYSTAGMUS $22.00 20010101 99999999 92533 CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, $28.00 19990701 99999999 92541 SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION $35.89 20060701 99999999 92542 POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH $36.89 20060701 99999999 92543 CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL $17.05 20060701 99999999 92544 OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL $29.23 20060701 99999999 92545 OSCILLATING TRACKING TEST, WITH RECORDING $26.01 20060701 99999999 92546 TORSION SWING TEST, WITH RECORDING $57.44 20060701 99999999 92547 USE OF VERTICAL ELECTRODES IN ANY OR ALL OF ABOVE TESTS $5.21 20060701 99999999 92548 COMPUTERIZED DYNAMIC POSTUROGRAPHY $75.05 20060701 99999999 92551 SCREENING TEST, PURE TONE, AIR ONLY $10.13 19990701 99999999 92552 PURE TONE AUDIOMETRY (THRESHOLD) $15.10 20060701 99999999 92553 PURE TONE AUDIOMETRY (THRESHOLD) $22.15 20060701 99999999 92555 SPEECH AUDIOMETRY $12.92 20060701 99999999 92556 SPEECH AUDIOMETRY $19.35 20060701 99999999 92557 BASIC COMPREHENSIVE AUDIOMETRY (92553 AND 92556 COMBINED), (PURE $40.56 20060701 99999999 92561 BEKESY AUDIOMETRY $24.03 20060701 99999999 92562 LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURAL $13.85 20060701 99999999 92563 TONE DECAY TEST $12.92 20060701 99999999 92564 SHORT INCREMENT SENSITIVITY INDEX (SISI) $16.29 20060701 99999999 92565 STENGER TEST, PURE TONE $13.54 20060701 99999999 92567 TYMPANOMETRY $17.78 20060701 99999999 92568 ACOUSTIC REFLEX TESTING $12.92 20060701 99999999 92569 ACOUSTIC REFLEX DECAY TEST $13.85 20060701 99999999 92571 FILTERED SPEECH TEST $13.23 20060701 99999999 92572 STAGGERED SPONDAIC WORD TEST $3.06 20060701 99999999 92573 LOMBARD TEST $11.90 19990701 99999999 92575 SENSORINEURAL ACUITY LEVEL TEST $10.17 20060701 99999999 92576 SYNTHETIC SENTENCE IDENTIFICATION TEST $15.35 20060701 99999999 92577 STENGER TEST, SPEECH $24.27 20060701 99999999 92579 VISUAL REINFORCEMENT AUDIOMETRY (VRA) $24.34 20060701 99999999 92582 CONDITIONING PLAY AUDIOMETRY $24.34 20060701 99999999 92583 SELECT PICTURE AUDIOMETRY $30.14 20060701 99999999 92584 ELECTROCOCHLEOGRAPHY $83.43 20060701 99999999 92585 BRAINSTEM EVOKED RESPONSE RECORDING $102.83 20060701 99999999 92586 AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE $53.88 20060701 99999999 92587 EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT O $50.22 20060701 99999999 92588 EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION (COMPARISON $66.75 20060701 99999999 92589 CENTRAL AUDITORY FUNCTION TEST(S) (SPECIFY) $18.10 19990701 99999999 92590 HEARING AID EXAMINATION AND SELECTION $82.87 19990701 99999999 92591 HEARING AID EXAMINATION AND SELECTION $84.00 19990701 99999999 92592 HEARING AID CHECK $22.71 19990701 99999999 92593 HEARING AID CHECK $25.15 19990701 99999999 92594 ELECTROACOUSTIC EVALUATION FOR HEARING AID $42.65 19990701 99999999 92595 ELECTROACOUSTIC EVALUATION FOR HEARING AID $59.75 19990701 99999999 92596 EAR PROTECTOR ATTENUATION MEASUREMENTS $19.97 20060701 99999999 92597 EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC OR AUGMENTATIVE/ALTERNATIV $49.72 20030401 99999999 92598 MODIFICATION OF VOICE PROSTHETIC OR AUGMENTATIVE/ALTERNATIVE COMMUNICATION DEVIC $53.62 19990701 99999999 92601 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; WITH PROG $105.52 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 276
PROC-CODE DESC MAC BEG END 92602 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; SUBSEQUEN $73.97 20060701 99999999 92603 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; WITH PROGRAMMING $70.98 20060701 99999999 92604 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; SUBSEQUENT REPROG $48.36 20060701 99999999 92606 THERAPEUTIC SERVICE(S) FOR THE USE OF NON-SPEECH- GENERATING DEVICE, INCLUDING PR $45.54 20030101 99999999 92607 EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE C $88.11 20060701 99999999 92608 EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE C $17.26 20060701 99999999 92609 THERAPEUTIC SERVICES FOR THE USE OF SPEECH-GENERATING DEVICE, INCLUDING PROGRAMM $47.70 20060701 99999999 92610 EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION $88.36 20060701 99999999 92611 MOTION FLUOROSCOPIC EVALUATION OF SWALLOWING FUNCTION BY CINE OR VIDEO RECORDING $88.36 20060701 99999999 92612 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO RECORDI $49.97 20060701 99999999 92613 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO RECORDI $26.99 20060701 99999999 92614 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR $49.97 20060701 99999999 92615 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR $24.15 20060701 99999999 92616 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSORY TE $72.92 20060701 99999999 92617 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSORY TE $30.08 20060701 99999999 92620 EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; INITIAL 60 MINUTES $36.09 20060701 99999999 92621 EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; EACH ADDITIONAL 15 MINUTES $8.94 20060701 99999999 92625 ASSESSMENT OF TINNITUS (INCLUDES PITCH, LOUDNESS MATCHING, AND MASKING) $35.47 20060701 99999999 92626 EVALUATION OF AUDITORY REHABILITATION STATUS; FIRST HOUR $56.67 20060701 99999999 92627 EVALUATION OF AUDITORY REHABILITATION STATUS; EACH ADDITIONAL 15 MINUTES (LIST S $16.69 20060701 99999999 92630 AUDITORY REHABILITATION; PRE-LINGUAL HEARING LOSS $88.44 20060101 99999999 92633 AUDITORY REHABILITATION; POST-LINGUAL HEARING LOSS $88.44 20060101 99999999 92640 DIAGNOSTIC ANALYSIS WITH PROGRAMMING OF AUDITORY BRAINSTEM IMPLANT, PER HOUR $41.55 20070101 99999999 92950 CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST) $168.25 20060701 99999999 92953 TEMPORARY TRANSCUTANEOUS PACING $11.61 20060701 99999999 92960 CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF $125.14 20060701 99999999 92961 CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; INTERNAL (SEPARATE $176.85 20060701 99999999 92970 CARDIOASSIST-METHOD OF CIRCULATORY ASSIST $172.04 20060701 99999999 92971 CARDIOASSIST-METHOD OF CIRCULATORY ASSIST $78.33 20060701 99999999 92973 PERCUTANEOUS TRANSLUMINAL CORONARY THROMBECTOMY (LIST SEPARATELY IN ADDITION TO $129.06 20060701 99999999 92974 TRANSCATHETER PLACEMENT OF RADIATION DELIVERY DEVICE FOR SUBSEQUENT CORONARY INT $140.52 20060701 99999999 92975 THROMBOLYSIS, CORONARY $340.98 19990701 99999999 92977 THROMBOLYSIS, CORONARY $265.85 19990701 99999999 92978 INTRAVASCULAR ULTRASOUND (CORONARY VESSEL/GRAFT) DURING THERAPEUTIC INTERVENTION $229.41 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 277
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