Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 97760 ORTHOTIC(S) MANAGEMENT AND TRAINING (INCLUDING ASSESSMENT AND FITTING WHEN NOT O $17.21 20060701 99999999 97761 PROSTHETIC TRAINING, UPPER AND/OR LOWER EXTREMITY(S), EACH 15 MINUTES $17.70 20060701 99999999 97762 CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT, EACH 15 MINUTES $12.11 20060701 99999999 97770 DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING, I $20.25 19990701 99999999 97802 MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE $13.40 20010101 99999999 97803 MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE-TO-F $13.40 20010101 99999999 97804 MEDICAL NUTRITION THERAPY; GROUP (2 OR MORE INDIVIDUAL(S)), EACH 30 MINUTES $5.20 20010101 99999999 98925 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); ONE TO TWO BODY REGIONS INVOLVED $22.01 20060701 99999999 98926 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); THREE TO FOUR BODY REGIONS INVOLVED $30.70 20060701 99999999 98927 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); FIVE TO SIX BODY REGIONS INVOLVED $37.99 20060701 99999999 98928 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); SEVEN TO EIGHT BODY REGIONS INVOLVED $43.75 20060701 99999999 98929 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); NINE TO TEN BODY REGIONS INVOLVED $53.93 20060701 99999999 99025 INITIAL (NEW PATIENT) VISIT WHEN STARRED (*) SURGICAL $14.00 19990701 99999999 99052 SERVICES REQUESTED BETWEEN 10:00 PM AND 8:00 AM IN ADDITION $23.46 19990701 99999999 99056 SERVICES PROVIDED AT REQUEST OF PATIENT IN A LOCATION OTHER $37.80 19990701 99999999 99071 EDUCATIONAL SUPPLIES, SUCH AS BOOKS, TAPES, AND PAMPHLETS, PROVIDED $2.63 19990701 99999999 99080 SPECIAL REPORTS SUCH AS INSURANCE FORMS, OR THE REVIEW OF MEDICAL $125.00 19990701 99999999 99082 UNUSUAL TRAVEL (EG, TRANSPORTATION AND ESCORT OF PATIENT) $8.00 19990701 99999999 99170 GASTRIC INTUBATION, AND ASPIRATION OR LAVAGE FOR TREATMENT $89.60 20060701 99999999 99175 IPECAC OR SIMILAR ADMINISTRATION FOR INDIVIDUAL EMESIS AND $46.30 20060701 99999999 99183 PHYSICIAN ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN THERAPY, PER SESSION $74.57 20060701 99999999 99185 HYPOTHERMIA $21.02 20060701 99999999 99186 HYPOTHERMIA $66.31 20060701 99999999 99195 PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE) $14.85 20060701 99999999 99201 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATI $24.13 20060701 99999999 99202 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATI $48.03 20060701 99999999 99203 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATI $68.82 20060701 99999999 99204 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATI $99.17 20060701 99999999 99205 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATI $122.28 20060701 99999999 99211 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLI $9.17 20060701 99999999 99212 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLI $24.13 20060701 99999999 99213 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLI $36.31 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 290
PROC-CODE DESC MAC BEG END 99214 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLI $56.46 20060701 99999999 99215 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLI $83.57 20060701 99999999 99217 OBSERVATION CARE DISCHARGE DAY MANAGEMENT (THIS CODE IS TO BE UTILIZED BY THE PH $50.53 20060701 99999999 99218 INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN $53.33 19990701 99999999 99219 INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN $87.31 19990701 99999999 99220 INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN $116.67 19990701 99999999 99221 INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT W $53.33 20060701 99999999 99222 INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, $87.63 20060701 99999999 99223 INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, $116.67 20060701 99999999 99231 SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN $27.32 20060701 99999999 99232 SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN $42.31 20060701 99999999 99233 SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN $59.39 20060701 99999999 99234 OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A P $95.13 20060701 99999999 99235 OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A P $128.86 20060701 99999999 99236 OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A P $157.96 20060701 99999999 99238 HOSPITAL DISCHARGE DAY MANAGEMENT $50.28 20060701 99999999 99239 HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES $65.64 20060701 99999999 99241 OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE $34.65 20060701 99999999 99242 OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE $70.83 20060701 99999999 99243 OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE $90.55 20060701 99999999 99244 OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE $124.60 20060701 99999999 99245 OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE $161.44 20060701 99999999 99251 INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES $34.27 20060701 99999999 99252 INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES $58.26 20060701 99999999 99253 INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES $77.90 20060701 99999999 99254 INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES $108.71 20060701 99999999 99255 INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES $148.14 20060701 99999999 99261 FOLLOW-UP INPATIENT CONSULTATION FOR AN ESTABLISHED PATIENT, WHICH REQUIRES AT L $20.28 19990701 99999999 99262 FOLLOW-UP INPATIENT CONSULTATION FOR AN ESTABLISHED PATIENT WHICH REQUIRES AT LE $36.53 19990701 99999999 99263 FOLLOW-UP INPATIENT CONSULTATION FOR AN ESTABLISHED PATIENT WHICH REQUIRES AT LE $54.01 19990701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 291
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