Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 94770 CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY INFRARED ANALYZER $23.83 20060701 99999999 94799 UNLISTED PULMONARY SERVICE OR PROCEDURE $20.00 20010101 99999999 95004 PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH ALLERGENIC EXTRACTS, IMMEDIAT $3.37 20060701 99999999 95010 PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) SEQUENTIAL AND INCREMENTAL, WITH D $8.42 20060701 99999999 95012 NITRIC OXIDE EXPIRED GAS DETERMINATION $14.38 20070101 99999999 95015 INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH DRUGS, BIOL $8.42 20060701 99999999 95024 INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REAC $4.93 20060701 99999999 95027 SKIN END POINT TITRATION $4.93 20060701 99999999 95028 INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, DELAYED TYPE REACTI $7.73 20060701 99999999 95044 PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS) $6.80 20060701 99999999 95052 PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS) $8.36 20060701 99999999 95056 PHOTO TESTS $5.87 20060701 99999999 95060 OPHTHALMIC MUCOUS MEMBRANE TESTS $11.73 20060701 99999999 95065 DIRECT NASAL MUCOUS MEMBRANE TEST $6.80 20060701 99999999 95070 INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING $73.17 20060701 99999999 95071 INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING $93.43 20060701 99999999 95075 INGESTION CHALLENGE TEST (EG, METABISULFITE) $52.64 20060701 99999999 95078 PROVOCATIVE TESTING (EG, RINKEL TEST) $8.61 19990701 99999999 95115 PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING $12.97 20060701 99999999 95117 PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUD $16.72 20060701 99999999 95144 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN $3.38 20060701 99999999 95145 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF $3.38 20060701 99999999 95146 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF $3.80 20060701 99999999 95147 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF $3.38 20060701 99999999 95148 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF $3.80 20060701 99999999 95149 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF $3.80 20060701 99999999 95165 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN $3.38 20060701 99999999 95170 PROFESSIONAL SERVICE FOR THE SUPERVISION AND PROVISION OF $3.38 20060701 99999999 95180 RAPID DESENSITIZATION PROCEDURE, EACH HOUR (EG, INSULIN, $80.90 20060701 99999999 95250 GLUCOSE MONITORING FOR UP TO 72 HOURS BY CONTINUOUS RECORDING AND STORAGE OF GLU $104.01 20060701 99999999 95251 AMBULATORY CONTINUOUS GLUCOSE MONITORING OF INTERSTITIAL TISSUE FLUID VIA A SUBC $18.98 20060701 99999999 95805 MULTIPLE SLEEP LATENCY TESTING RECORDING,ANALYSIS & INTERPRE $488.08 20060701 99999999 95806 SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR H $209.21 19990701 99999999 95807 SLEEP STUDY, 3 OR MORE PARAMETERS OF SLEEP OTHER THAN SLEEP STAGING, ATTENDED BY $347.15 20060701 99999999 95808 POLYSOMNOGRAPHY; SLEEP STAGING WITH 1-3 ADDITIONAL PARAMETERS OF SLEEP, ATTENDED $404.78 20060701 99999999 95810 POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, AT $534.28 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 284
PROC-CODE DESC MAC BEG END 95811 POLYSOMNOGRAPHY; OF SLEEP, ATTENDED BY A TECHNOLOGIST SLEEP STAGING WITH 4 OR MO $583.76 20060701 99999999 95812 ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; UP TO ONE HOUR $129.83 20060701 99999999 95813 ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; GREATER THAN ONE HOUR $170.24 20060701 99999999 95816 EEG INCLUDING RECORDING AWAKE & DROWSY,WITH HYPERVENTILATION $121.57 20060701 99999999 95819 ELECTROENCEPHALOGRAM (EEG) INCLUDING RECORDING AWAKE, DROWSY, $103.13 20060701 99999999 95822 ELECTROENCEPHALOGRAM (EEG) $144.59 20060701 99999999 95824 ELECTROENCEPHALOGRAM (EEG) $43.18 19990701 99999999 95827 ELECTROENCEPHALOGRAM (EEG) $126.31 20060701 99999999 95829 ELECTROCORTICOGRAM AT SURGERY (SEPARATE PROCEDURE) $936.19 20060701 99999999 95830 INSERTION BY PHYSICIAN OF SPHENOIDAL ELECTRODES FOR $70.81 20060701 99999999 95831 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) $12.30 20060701 99999999 95832 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) $12.25 20060701 99999999 95833 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) $16.91 20060701 99999999 95834 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) $25.96 20060701 99999999 95851 RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE) $7.89 20060701 99999999 95852 RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE) $5.33 20060701 99999999 95857 TENSILON TEST FOR MYASTHENIA GRAVIS $22.24 20060701 99999999 95858 TENSILON TEST FOR MYASTHENIA GRAVIS $76.99 19990701 99999999 95860 ELECTROMYOGRAPHY $59.08 20060701 99999999 95861 ELECTROMYOGRAPHY $98.48 20060701 99999999 95863 ELECTROMYOGRAPHY $118.33 20060701 99999999 95864 ELECTROMYOGRAPHY $156.68 20060701 99999999 95865 NEEDLE ELECTROMYOGRAPHY; LARYNX $82.98 20060701 99999999 95866 NEEDLE ELECTROMYOGRAPHY; HEMIDIAPHRAGM $55.22 20060701 99999999 95867 ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES $55.97 20060701 99999999 95868 ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES $84.46 20060701 99999999 95869 ELECTROMYOGRAPHY, LIMITED STUDY OF SPECIFIC MUSCLES (EG, $25.46 20060701 99999999 95870 NEEDLE ELECTROMYOGRAPHY; OTHER THAN PARASPINAL (EG, ABDOMEN, THORAX) $25.46 20060701 99999999 95872 ELECTROMYOGRAPHY, SINGLE FIBER, ANY TECHNIQUE $82.21 20060701 99999999 95873 ELECTRICAL STIMULATION FOR GUIDANCE IN CONJUNCTION WITH CHEMODENERVATION (LIST S $20.36 20060701 99999999 95874 NEEDLE ELECTROMYOGRAPHY FOR GUIDANCE IN CONJUNCTION WITH CHEMODENERVATION (LIST $20.64 20060701 99999999 95875 ISCHEMIC LIMB EXERCISE WITH EMG, WITH LACTIC ACID DETERMINATION $63.77 20060701 99999999 95900 NERVE CONDUCTION, VELOCITY AND/OR LATENCY STUDY $42.16 20060701 99999999 95903 NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE, ANY/ALL SITE $44.68 20060701 99999999 95904 NERVE CONDUCTION, VELOCITY AND/OR LATENCY STUDY $36.04 20060701 99999999 95920 INTRAOPERATIVE NEUROPHYSIOLOGY TESTING, PER HOUR $108.99 20060701 99999999 95921 TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION: CARDIOVAGAL INNERVATION (PARASYMPA $47.70 20060701 99999999 95922 TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; CARDIOVAGAL INNERVATION (PARASYMPA $50.78 20060701 99999999 95923 TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION: CARDIOVAGAL INNERVATION (PARASYMPA $83.82 20060701 99999999 95925 SOMATOSENSORY TESTING (EG, CEREBRAL EVOKED POTENTIALS), $59.31 20060701 99999999 95926 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIP $59.31 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 285
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