Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 96412 CHEMOTHERAPY ADMIN.,IV INFUSION TECHNIQUE, ONE TO 8 HOURS $38.31 19990701 99999999 96413 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; UP TO 1 HOUR, SINGL $113.96 20060701 99999999 96414 CHEMOTHERAPY ADMIN, IV INFUSION TECHNIQUE,INITIAT. OF PROLON $44.17 19990701 99999999 96415 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL HOU $38.31 20060701 99999999 96416 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; INITIATION OF PROLO $122.71 20060701 99999999 96417 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL SEQ $55.33 20060701 99999999 96420 CHEMOTHERAPY ADMINISTRATION,INTRA-ARTERIAL PUSH TECHNIQUE $72.79 20060701 99999999 96422 CHEMOTHERAPY ADMIN,INTRA-ARTERIAL INFUSION TECHNIQUE,UP TO 1 $127.61 20060701 99999999 96423 CHEMOTHERAPY ADMIN,INTRA-ARTERIAL INFUSION TECHNIQUE,1-8 HRS $52.00 20060701 99999999 96425 CHEMOTHERAPY ADMIN,INTRA-ARTERIAL INFUSION TECHNIQUE $118.52 20060701 99999999 96440 CHEMOTHERAPY INTROCAVITARY $144.80 20060701 99999999 96445 CHEMOTHERAPY ADMINISTRATION INTO PERITONEAL CAVITY $134.52 20060701 99999999 96450 CHEMOTHERAPY LUMBAR PUNCTURE $118.87 20060701 99999999 96520 PORTABLE PUMP REFILLING AND MAINTENANCE $29.64 19990701 99999999 96521 REFILLING AND MAINTENANCE OF PORTABLE PUMP $101.13 20060701 99999999 96522 REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SY $72.83 20060701 99999999 96523 IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS $20.64 20060701 99999999 96530 IMPLANTABLE PUMP FILLING AND MAINTENANCE $35.25 19990701 99999999 96542 CHEMOTHERAPY INJECTION, SUBARACHNOID OR INTRAVENTRICULAR VIA SUBCUTANEOUS RESERV $82.55 20060701 99999999 96549 UNLISTED CHEMOTHERAPY PROCEDURE $41.60 20030401 99999999 96567 PHOTODYNAMIC THERAPY BY EXTERNAL APPLICATION OF LIGHT TO DESTROY PREMALIGNANT AN $50.24 20060701 99999999 96570 PHOTODYNAMIC THERAPY BY ENDOSCOPIC APPLICATION OF LIGHT TO ABLATE ABNORMAL TISSU $58.12 20060701 99999999 96571 PHOTODYNAMIC THERAPY BY ENDOSCOPIC APPLICATION OF LIGHT TO ABLATE ABNORMAL TISSU $29.40 20060701 99999999 96900 ACTINOTHERAPY (ULTRAVIOLET LIGHT) $13.29 20060701 99999999 96910 PHOTOCHEMOTHERAPY $25.74 20060701 99999999 96912 PHOTOCHEMOTHERAPY $32.74 20060701 99999999 96913 PHOTOCHEMOTHERAPY FOR SEVERE PHOTORESPONSIVE DERMATOSES $45.05 20060701 99999999 96920 LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); TOTAL AREA LESS THAN $45.75 20060701 99999999 96921 LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); 250 SQ CM TO 500 SQ C $46.58 20060701 99999999 96922 LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); OVER 500 SQ CM $83.40 20060701 99999999 97001 PHYSICAL THERAPY EVALUATION $46.55 20060701 99999999 97002 PHYSICAL THERAPY RE-EVALUATION $20.66 20060701 99999999 97003 OCCUPATIONAL THERAPY EVALUATION $44.99 20060701 99999999 97004 OCCUPATIONAL THERAPY RE-EVALUATION $20.03 20060701 99999999 97010 PHYSICAL MEDICINE TREATMENT TO ONE AREA $10.08 19990701 99999999 97012 PHYSICAL MEDICINE TREATMENT TO ONE AREA $13.69 20060701 99999999 97014 PHYSICAL MEDICINE TREATMENT TO ONE AREA $11.85 19990701 99999999 97016 PHYSICAL MEDICINE TREATMENT TO ONE AREA $12.49 20060701 99999999 97018 PHYSICAL MEDICINE TREATMENT TO ONE AREA $6.82 20060701 99999999 97020 PHYSICAL MEDICINE TREATMENT TO ONE AREA $4.50 19990701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 288
PROC-CODE DESC MAC BEG END 97022 PHYSICAL MEDICINE TREATMENT TO ONE AREA $11.89 20060701 99999999 97024 PHYSICAL MEDICINE TREATMENT TO ONE AREA $4.50 20060701 99999999 97026 PHYSICAL MEDICINE TREATMENT TO ONE AREA $4.50 20060701 99999999 97028 PHYSICAL MEDICINE TREATMENT TO ONE AREA $5.63 20060701 99999999 97032 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), $13.64 20060701 99999999 97033 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES $13.64 20060701 99999999 97034 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES $11.39 20060701 99999999 97035 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES $9.52 20060701 99999999 97036 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES $16.04 20060701 99999999 97039 PHYSICAL MEDICINE TREATMENT TO ONE AREA $10.37 19990701 99999999 97110 PHYSICAL MEDICINE TREATMENT TO ONE AREA, INITIAL 30 MINUTES, $17.65 20060701 99999999 97112 PHYSICAL MEDICINE TREATMENT TO ONE AREA, INITIAL 30 MINUTES, $18.58 20060701 99999999 97113 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH $20.09 20060701 99999999 97116 PHYSICAL MEDICINE TREATMENT TO ONE AREA, INITIAL 30 MINUTES, $16.70 20060701 99999999 97124 PHYSICAL MEDICINE TREATMENT TO ONE AREA, INITIAL 30 MINUTES, $15.39 20060701 99999999 97139 PHYSICAL MEDICINE TREATMENT TO ONE AREA, INITIAL 30 MINUTES, $12.02 19990701 99999999 97140 MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAI $20.55 20060701 99999999 97150 THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS) $14.78 19990701 99999999 97504 ORTHOTICS FITTING & TRAINING, UPPER AND/OR LOWER EXTREMITIESEACH 15 MIN $18.83 19990701 99999999 97520 PROSTHETIC TRAINING $18.89 19990701 99999999 97530 KINETIC ACTIVITIES TO INCREASE COORDINATION, STRENGTH $18.32 20060701 99999999 97532 DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING, ( $16.63 20060701 99999999 97533 SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIV $17.81 20060701 99999999 97535 SELF CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND COM $19.20 20060701 99999999 97537 COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING, TRANSPORTATION, MONEY MANAG $18.95 19990701 99999999 97542 WHEELCHAIR MANAGEMENT/PROPULSION TRAINING, EACH 15 MINUTES $17.54 20060701 99999999 97597 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANES $37.07 20060701 99999999 97598 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT $47.04 20060701 99999999 97601 REMOVAL OF DEVITALIZED TISSUE FROM WOUND; SELECTIVE DEBRIDEMENT, WITHOUT ANESTHE $40.76 20041001 99999999 97602 REMOVAL OF DEVITALIZED TISSUE FROM WOUND; NON-SELECTIVE DEBRIDEMENT, WITHOUT ANE $20.46 20010101 99999999 97605 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), $18.49 20060701 99999999 97606 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), $20.32 20060701 99999999 97703 CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT, EACH 15 MINUTES $11.82 19990701 99999999 97750 PHYSICAL PERFORMANCE TEST OR MEASUREMENT (EG, MUSCULOSKELETAL, FUNCTIONAL CAPACI $19.83 20060701 99999999 97755 ASSISTIVE TECHNOLOGY ASSESSMENT (EG, TO RESTORE, AUGMENT OR COMPENSATE FOR EXIST $25.87 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 289
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