Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 92979 INTRAVASCULAR ULTRASOUND (CORONARY VESSEL/GRAFT) DURING THERAPEUTIC EACH ADDL $138.64 20060701 99999999 92980 TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITH $812.21 20060701 99999999 92981 TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITH $228.04 20060701 99999999 92982 PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY $600.24 20060701 99999999 92984 PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY $162.42 20060701 99999999 92986 PERCUTANEOUS BALLOON VALVULOPLASTY; AORTIC VALVE $1,018.07 20060701 99999999 92987 PERCUTANEOUS BALLOON VALVULOPLASTY; MITRAL VALVE $1,053.82 20060701 99999999 92990 PERCUTANEOUS BALLOON VALVULOPLASTY; PULMONARY VALVE $799.62 20060701 99999999 92992 ATRIAL SEPTECTOMY OR SEPTOSTOMY; TRANSVENOUS METHOD, BALLOON, RASHKIND TYPE (INC $603.65 19990701 99999999 92995 PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, WITH OR WITHOUT BALLOON ANGIOPLA $661.24 20060701 99999999 92996 PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, WITH OR WITHOUT BALLOON ANGIOPLA $178.22 20060701 99999999 92997 PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; SINGLE VESSEL $637.24 20060701 99999999 92998 PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; EACH ADDITIONAL $278.81 20060701 99999999 93000 ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS $23.63 20060701 99999999 93005 ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS $15.16 20060701 99999999 93010 ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS $8.47 20060701 99999999 93012 TELEPHONIC OR TELEMETRIC TRANSMISSION OF $155.61 20060701 99999999 93014 TELEPHONIC OR TELEMETRIC TRANSMISSION OF $24.16 20060701 99999999 93015 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL $92.98 20060701 99999999 93016 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXER $21.45 20060701 99999999 93017 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL $55.90 20060701 99999999 93018 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL $15.63 20060701 99999999 93024 ERGONOVINE PROVOCATION TEST $98.73 20060701 99999999 93025 MICROVOLT T-WAVE ALTERNANS FOR ASSESSMENT OF VENTRICULAR ARRHYTHMIAS $211.93 20060701 99999999 93040 RHYTHM ECG, ONE TO THREE LEADS $12.20 20060701 99999999 93041 RHYTHM ECG, ONE TO THREE LEADS $4.93 20060701 99999999 93042 RHYTHM ECG, ONE TO THREE LEADS $7.26 20060701 99999999 93224 ELECTROCARDIOGRAPHIC MONITORING FOR 24HOURS BY CONTINUOUS $140.59 20060701 99999999 93225 ELECTROCARDIOGRAPHIC MONITORING FOR 24HRS BY CONTINUOUS ECG $41.05 20060701 99999999 93226 ELECTROCARDIOGRAPHIC MONITOR 24HRS BY CONTIN. ORIG. ECG WAVE $72.56 20060701 99999999 93227 ELECTROCARDIOGRAPHIC MONITORING 24HRS,WITH VISUAL SUPERIMPOS $26.97 20060701 99999999 93230 ELECTROCARDIOGRAPHIC ORIG. ECG WAVEFORM RECORD & STORAGE $149.57 20060701 99999999 93231 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS $50.60 20060701 99999999 93232 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS $72.00 20060701 99999999 93233 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS $26.97 20060701 99999999 93235 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS $109.61 20060701 99999999 93236 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS $86.28 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 278
PROC-CODE DESC MAC BEG END 93237 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS $23.32 20060701 99999999 93268 PATIENT DEMAND SINGLE EVENT ECG RECORDING $205.43 20060701 99999999 93270 ELECTROCARDIOGRAPHIC MONITORING UTILIZING A SYSTEM SUCH AS $41.05 20060701 99999999 93271 ELECTROCARDIOGRAPHIC MONITORING UTILIZING A SYSTEM SUCH AS $155.61 20060701 99999999 93272 ELECTROCARDIOGRAPHIC MONITORING UTILIZING A SYSTEM SUCH AS $23.85 20060701 99999999 93278 SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH OR WITHOUT ECG $52.13 20060701 99999999 93303 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENIAL CARDIAC ANOMALIES; COMPLETE $187.44 20060701 99999999 93304 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENIAL CARDIAC ANOMALIES/FOLLOW UP LTD STD $100.97 20060701 99999999 93307 ECHOCARDIOGRAPHY, REAL-TIME WITH IMAGE DOCUMENTATION (2D) $175.94 20060701 99999999 93308 ECHOCARDIOGRAPHY, REAL-TIME WITH IMAGE DOCUMENTATION (2D) $92.06 20060701 99999999 93312 ECHOCARDIOGRAPHY,REAL TIME W/DOC., TRANSESOPHAGEAL $223.29 20060701 99999999 93313 ECHOCARDIOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MOD $46.11 20060701 99999999 93314 ECHOCARDIOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MOD $179.58 20060701 99999999 93315 TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENIAL CARDIAC ANOMALIES; INCLUDING PROB $242.18 19990701 99999999 93316 TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC PLACEMENT OF PROBE ONLY $47.37 20060701 99999999 93317 TRANSESOPHAGEAL ECHOCARDIOGRAPHY/IMAGE ACQUISITION, INTERPRETATION AND REPORT $199.34 19990701 99999999 93320 DOPPLER ECHOCARDIOGRAPHY $77.00 20060701 99999999 93321 DOPPLER ECHOCARDIOGRAPHY; FLUOR LIMITED $45.25 20060701 99999999 93325 DOPPLER COLORFLOW VELOCITY FOR MAPPING EKG $100.18 20060701 99999999 93350 ECHOCARDIOGRAPHY,REAL-TIME WITH IMAGE DOCUMENTATION $99.58 20060701 99999999 93501 RIGHT HEART CATHETERIZATION $719.33 20060701 99999999 93503 RIGHT HEART CATHETERIZATION $138.23 20060701 99999999 93505 ENDOMYOCARDIAL BIOPSY $275.05 20060701 99999999 93508 CATHETER PLACEMENT IN CORONARY ARTERY(S), ARTERIAL CORONARY CONDUIT(S), AND/OR V $607.00 20060701 99999999 93510 LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL $1,423.00 20060701 99999999 93511 LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL $1,408.43 20060701 99999999 93514 LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL $1,513.52 19990701 99999999 93524 COMBINED TRANSSEPTAL AND RETROGRADE LEFT HEART CATHETERIZATION $1,875.07 20060701 99999999 93526 COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART $1,895.83 20060701 99999999 93527 COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT $1,928.85 20060701 99999999 93528 COMBINED RIGHT HEART CATHETERIZATION WITH LEFT VENTRICULAR $1,946.97 20060701 99999999 93529 COMBINED RIGHT HEART CATHETERIZATION AND LEFT HEAR CATHETERI $1,764.60 20060701 99999999 93530 RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES $767.74 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 279
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