Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 93886 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY $200.44 20060701 99999999 93888 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; FOLLOW-UP OR LIMITED ST $127.36 20060701 99999999 93890 NON-INVASIVE STUDIES OF UPPER EXTREMITY ARTERIES (EG, $186.62 20060701 99999999 93892 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION $198.64 20060701 99999999 93893 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITH $194.68 20060701 99999999 93922 NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, SINGLE LEV $76.40 20060701 99999999 93923 NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, MULTIPLE L $117.07 20060701 99999999 93924 NONINVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND FOLLOWI $138.14 20060701 99999999 93925 DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILA $192.13 20060701 99999999 93926 DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; FOLLOW-UP OR $116.39 20060701 99999999 93930 DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILA $156.25 20060701 99999999 93931 DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; FOLLOW-UP OR $103.76 20060701 99999999 93965 NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, BILATERAL, (EG, CONTINUOUS $81.28 20060701 99999999 93970 DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANE $169.29 20060701 99999999 93971 DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANE $112.56 20060701 99999999 93975 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, AND/OR R $244.58 20060701 99999999 93976 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, AND/OR R $149.97 20060701 99999999 93978 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; C $149.97 20060701 99999999 93979 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; F $105.87 20060701 99999999 93980 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE ST $173.48 20060701 99999999 93981 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP O $130.77 20060701 99999999 93982 NONINVASIVE PHYSIOLOGIC STUDY OF IMPLANTED WIRELESS PRESSURE SENSOR IN ANEURYSMA $24.04 20080101 99999999 93990 DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AN $111.49 20060701 99999999 94002 VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI $59.64 20070101 99999999 94003 VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI $43.79 20070101 99999999 94004 VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI $31.91 20070101 99999999 94010 SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL $24.25 20060701 99999999 94014 PATIENT INITIATED SPIROMETRIC RECORDING PER 30 DAY PERIOD OF TIME; INCLUDES REIN $33.77 20060701 99999999 94015 PATIENT INITIATED SPIROMETRIC RECORDING PER 30 DAY PERIOD OF TIME; RECORDING (IN $15.08 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 282
PROC-CODE DESC MAC BEG END 94016 PATIENT INITIATED SPIROMETRIC RECORDING PER 30 DAY PERIOD OF TIME; PHYSICIAN REV $20.42 20060701 99999999 94060 BRONCHOSPASM EVALUATION: SPIROMETRY AS IN 94010, BEFORE AND $46.78 20060701 99999999 94070 PROLONGED POSTEXPOSURE EVALUATION OF BRONCHOSPASM WITH $61.45 20060701 99999999 94150 VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE) $7.54 19990701 99999999 94200 MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION $14.25 20060701 99999999 94240 FUNCTIONAL RESIDUAL CAPACITY OR RESIDUAL VOLUME: HELIUM METHOD, $35.23 20060701 99999999 94250 EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE $19.04 20060701 99999999 94260 THORACIC GAS VOLUME $21.36 20060701 99999999 94350 DETERMINATION OF MALDISTRIBUTION OF INSPIRED GAS: MULTIPLE $29.99 20060701 99999999 94360 DETERMINATION OF RESISTANCE TO AIRFLOW, OSCILLATORY OR $31.54 20060701 99999999 94370 DETERMINATION OF AIRWAY CLOSING VOLUME, SINGLE BREATH TESTS $24.68 20060701 99999999 94375 RESPIRATORY FLOW VOLUME LOOP $29.49 20060701 99999999 94400 BREATHING RESPONSE TO CO2 (CO2 RESPONSE CURVE) $32.56 20060701 99999999 94450 BREATHING RESPONSE TO HYPOXIA (HYPOXIA RESPONSE CURVE) $31.34 20060701 99999999 94452 HIGH ALTITUDE SIMULATION TEST (HAST), WITH PHYSICIAN INTERPRETATION AND REPORT; $40.46 20060701 99999999 94453 HIGH ALTITUDE SIMULATION TEST (HAST), WITH PHYSICIAN INTERPRETATION AND REPORT; $57.86 20060701 99999999 94610 INTRAPULMONARY SURFACTANT ADMINISTRATION BY A PHYSICIAN THROUGH ENDOTRACHEAL TUB $43.49 20070101 99999999 94620 PULMONARY STRESS TESTING, SIMPLE OR COMPLEX $80.15 20060701 99999999 94621 PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OF CO2 PRODUCTION, O2 $104.05 20060701 99999999 94640 NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION $13.32 20060701 99999999 94642 AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS CARINII $5.50 19910101 99999999 94644 CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUC $27.58 20070101 99999999 94645 CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUC $10.46 20070101 99999999 94656 VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR $57.93 19990701 99999999 94657 VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR $36.94 19990701 99999999 94660 CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), $39.67 20060701 99999999 94662 CONTINUOUS NEGATIVE PRESSURE VENTILATION (CNP), INITIATION $29.54 20060701 99999999 94664 AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION, $14.35 20060701 99999999 94667 MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND $20.34 20060701 99999999 94668 MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND $16.41 20060701 99999999 94680 OXYGEN UPTAKE, EXPIRED GAS ANALYSIS $54.46 20060701 99999999 94681 OXYGEN UPTAKE, EXPIRED GAS ANALYSIS $70.85 20060701 99999999 94690 OXYGEN UPTAKE, EXPIRED GAS ANALYSIS $53.03 20060701 99999999 94720 CARBON MONOXIDE DIFFUSING CAPACITY, ANY METHOD $40.47 20060701 99999999 94725 MEMBRANE DIFFUSION CAPACITY $82.07 20060701 99999999 94750 PULMONARY COMPLIANCE STUDY, ANY METHOD $40.02 20060701 99999999 94760 NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION $2.29 20060701 99999999 94761 NONIVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION $4.77 20060701 99999999 94762 NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION $19.84 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 283
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