Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 95927 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIP $59.94 20060701 99999999 95928 CENTRAL MOTOR EVOKED POTENTIAL STUDY (TRANSCRANIAL MOTOR STIMULATION); UPPER $135.06 20060701 99999999 95929 CENTRAL MOTOR EVOKED POTENTIAL STUDY (TRANSCRANIAL MOTOR STIMULATION); LOWER $140.86 20060701 99999999 95930 VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL NERVOUS SYSTEM, CHECKERBOARD OR FL $65.38 20060701 99999999 95933 ORBICULARIS OCULI (BLINK) REFLEX, BY ELECTRODIAGNOSTIC TESTING $54.08 20060701 99999999 95934 H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD GASTROCNEMIUS/SOLEUS MUSCLE $30.64 20060701 99999999 95936 H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD MUSCLE OTHER THAN GASTROCNEMIUS/SO $31.69 20060701 99999999 95937 NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, $40.81 20060701 99999999 95950 MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS, $230.74 20060701 99999999 95951 MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS, $227.20 19990701 99999999 95953 MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY COMPUTERIZED PORTABLE 1 $334.74 20060701 99999999 95954 PHARMACOLOGICAL ACTIVATION DURING PROLONGED MONITORING $166.30 20060701 99999999 95955 ELECTROENCEPHALOGRAM (EEG) DURING NONINTRACRANIAL SURGERY $116.80 20060701 99999999 95956 MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR M $599.51 20060701 99999999 95957 DIGITAL ANALYSIS OF ELECTROENCEPHALOGRAM (EEG) (EG, FOR EPILEPTIC SPIKE ANALYSIS $134.27 20060701 99999999 95958 WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION, INCLUDING $254.26 20060701 99999999 95961 FUNCTIONAL CORTICAL MAPING,INITIAL HOUR OF PHYSICIAN ATTEND $168.18 20060701 99999999 95962 FUNCTIONAL CORTICAL MAPPING,EACH ADDITIONAL HOUR OF PHYSICIA $175.92 20060701 99999999 95970 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $16.65 20060701 99999999 95971 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $28.64 20060701 99999999 95972 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $55.14 20060701 99999999 95973 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $33.82 20060701 99999999 95974 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $115.07 20060701 99999999 95975 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $65.70 20060701 99999999 95978 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, $139.18 20060701 99999999 95979 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, $67.59 20060701 99999999 95980 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $21.16 20080101 99999999 95981 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $8.40 20080101 99999999 95982 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT $16.58 20080101 99999999 95990 REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SP $45.46 20060701 99999999 95991 REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SP $27.76 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 286
PROC-CODE DESC MAC BEG END 96000 COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VIDEO- TAPING AND 3-D KINEMATICS; $68.30 20020101 99999999 96001 COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VIDEO- TAPING AND 3-D KINEMATICS; $81.50 20020101 99999999 96002 DYNAMIC SURFACE ELECTROMYOGRAPHY, DURING WALKING OR OTHER FUNCTIONAL ACTIVITIES, $15.78 20020101 99999999 96003 DYNAMIC FINE WIRE ELECTROMYOGRAPHY, DURING WALKING OR OTHER FUNCTIONAL ACTIVITIE $14.66 20020101 99999999 96004 PHYSICIAN REVIEW AND INTERPRETATION OF COMPREHENSIVE COMPUTER BASED MOTION ANALY $69.60 20020101 99999999 96101 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INT $59.90 20060701 99999999 96103 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INT $16.31 20060701 99999999 96105 ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AN $59.90 20060701 99999999 96111 DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE, SOCIAL, $59.90 19990701 99999999 96115 NEUROBEHAVORIAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDG $59.90 19990701 99999999 96116 NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDG $61.95 20060701 99999999 96117 NEUROPSYCHOLOGICAL TESTING BATTERY (EG, HALSTEAD-REITAN, LURIA, WAIS-R) WITH INT $59.90 19990701 99999999 96118 NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECH $61.69 20060701 99999999 96120 NEUROPSYCHOLOGICAL TESTING (EG, WISCONSIN CARD SORTING TEST), ADMINISTERED BY A $18.17 20060701 99999999 96125 STANDARDIZED COGNITIVE PERFORMANCE TESTING (EG, ROSS INFORMATION PROCESSING ASSE $41.65 20080101 99999999 96150 HEALTH AND BEHAVIOR ASSESSMENT (EG, HEALTH-FOCUSED CLINICAL INTERVIEW, BEHAVIORA $19.58 20060701 99999999 96151 HEALTH AND BEHAVIOR ASSESSMENT (EG, HEALTH-FOCUSED CLINICAL INTERVIEW, BEHAVIORA $19.06 20060701 99999999 96152 HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO- FACE; INDIVIDUAL $18.24 20060701 99999999 96153 HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO- FACE; GROUP (2 OR MOR $3.99 20060701 99999999 96154 HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO- FACE; FAMILY (WITH TH $17.70 20060701 99999999 96155 HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO- FACE; FAMILY (WITHOUT $17.14 20020101 99999999 96400 CHEMOTHERAPY ADMIN SUBCATANEOUS OR INTRAMUSCULAR W OR W/O LO $4.73 19990701 99999999 96401 CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR; NON-HORMONAL ANTI-NE $34.54 20060701 99999999 96402 CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR; HORMONAL ANTI-NEOPLA $30.04 20060701 99999999 96405 CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; UP TO AND INCLUDING 7 LESIONS $30.10 20060701 99999999 96406 CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; MORE THAN 7 LESIONS $43.07 20060701 99999999 96408 CHEMOTHERAPY ADMINISTRATION INTRAVENOUS PUSH $32.13 19990701 99999999 96409 CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH TECHNIQUE, SINGLE OR INITIAL SUBS $80.60 20060701 99999999 96410 CHEMOTHERAPY ADMIN, IV INFUSION TECHNIQUE, UP TO ONE HOUR $48.31 19990701 99999999 96411 CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH TECHNIQUE, EACH ADDITIONAL SUBSTA $46.33 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 287
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