Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
PROC-CODE DESC MAC BEG END<br />
94770<br />
CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY INFRARED<br />
ANALYZER $23.83 20060701 99999999<br />
94799 UNLISTED PULMONARY SERVICE OR PROCEDURE $20.00 20010101 99999999<br />
95004<br />
PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH<br />
ALLERGENIC EXTRACTS, IMMEDIAT $3.37 20060701 99999999<br />
95010<br />
PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) SEQUENTIAL<br />
AND INCREMENTAL, WITH D $8.42 20060701 99999999<br />
95012 NITRIC OXIDE EXPIRED GAS DETERMINATION $14.38 20070101 99999999<br />
95015<br />
INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND<br />
INCREMENTAL, WITH DRUGS, BIOL $8.42 20060701 99999999<br />
95024<br />
INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC<br />
EXTRACTS, IMMEDIATE TYPE REAC $4.93 20060701 99999999<br />
95027 SKIN END POINT TITRATION $4.93 20060701 99999999<br />
95028<br />
INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC<br />
EXTRACTS, DELAYED TYPE REACTI $7.73 20060701 99999999<br />
95044 PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS) $6.80 20060701 99999999<br />
95052 PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS) $8.36 20060701 99999999<br />
95056 PHOTO TESTS $5.87 20060701 99999999<br />
95060 OPHTHALMIC MUCOUS MEMBRANE TESTS $11.73 20060701 99999999<br />
95065 DIRECT NASAL MUCOUS MEMBRANE TEST $6.80 20060701 99999999<br />
95070 INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING $73.17 20060701 99999999<br />
95071 INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING $93.43 20060701 99999999<br />
95075 INGESTION CHALLENGE TEST (EG, METABISULFITE) $52.64 20060701 99999999<br />
95078 PROVOCATIVE TESTING (EG, RINKEL TEST) $8.61 19990701 99999999<br />
95115<br />
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT<br />
INCLUDING $12.97 20060701 99999999<br />
95117<br />
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT<br />
INCLUD $16.72 20060701 99999999<br />
95144<br />
PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION<br />
OF ANTIGENS FOR ALLERGEN $3.38 20060701 99999999<br />
95145<br />
PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION<br />
OF $3.38 20060701 99999999<br />
95146<br />
PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION<br />
OF $3.80 20060701 99999999<br />
95147<br />
PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION<br />
OF $3.38 20060701 99999999<br />
95148<br />
PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION<br />
OF $3.80 20060701 99999999<br />
95149<br />
PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION<br />
OF $3.80 20060701 99999999<br />
95165<br />
PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION<br />
OF ANTIGENS FOR ALLERGEN $3.38 20060701 99999999<br />
95170 PROFESSIONAL SERVICE FOR THE SUPERVISION AND PROVISION OF $3.38 20060701 99999999<br />
95180 RAPID DESENSITIZATION PROCEDURE, EACH HOUR (EG, INSULIN, $80.90 20060701 99999999<br />
95250<br />
GLUCOSE MONITORING FOR UP TO 72 HOURS BY CONTINUOUS<br />
RECORDING AND STORAGE OF GLU $104.01 20060701 99999999<br />
95251<br />
AMBULATORY CONTINUOUS GLUCOSE MONITORING OF INTERSTITIAL<br />
TISSUE FLUID VIA A SUBC $18.98 20060701 99999999<br />
95805<br />
MULTIPLE SLEEP LATENCY TESTING RECORDING,ANALYSIS &<br />
INTERPRE $488.08 20060701 99999999<br />
95806<br />
SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION,<br />
RESPIRATORY EFFORT, ECG OR H $209.21 19990701 99999999<br />
95807<br />
SLEEP STUDY, 3 OR MORE PARAMETERS OF SLEEP OTHER THAN<br />
SLEEP STAGING, ATTENDED BY $347.15 20060701 99999999<br />
95808<br />
POLYSOMNOGRAPHY; SLEEP STAGING WITH 1-3 ADDITIONAL<br />
PARAMETERS OF SLEEP, ATTENDED $404.78 20060701 99999999<br />
95810<br />
POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL<br />
PARAMETERS OF SLEEP, AT $534.28 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 284