Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 00930 ANESTHESIA FOR PROCEDURES ON MALE EXTERNAL GENITALIA; ORCHIOPEXY, UNILATERAL OR $22.80 19990701 99999999 00932 ANESTHESIA FOR PROCEDURES ON MALE EXTERNAL GENITALIA; COMPLETE AMPUTATION OF PEN $22.80 19990701 99999999 00934 ANESTHESIA FOR PROCEDURES ON MALE EXTERNAL GENITALIA; RADICAL AMPUTATION OF PENI $22.80 19990701 99999999 00936 ANESTHESIA FOR PROCEDURES ON MALE EXTERNAL GENITALIA; RADICAL AMPUTATION OF PENI $22.80 19990701 99999999 00938 ANESTHESIA FOR PROCEDURES ON MALE EXTERNAL GENITALIA; INSERTION OF PENILE PROSTH $22.80 19990701 99999999 00940 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR $22.80 19990701 99999999 00942 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR $22.80 19990701 99999999 00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR $22.80 19990701 99999999 00946 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR $22.80 19990701 99999999 00948 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR $22.80 19990701 99999999 00950 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR $22.80 19990701 99999999 00952 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR $22.80 19990701 99999999 00955 CONTINUOUS EPIDURAL ANALGESIA, FOR LABOR AND VAGINAL DELIVERY $22.80 19990701 99999999 01000 ANESTHESIA FOR PROCEDURES ON ANTERIOR INTEGUMENTARY SYSTEM OF PELVIS (ANTERIOR T $22.80 19990701 99999999 01110 PROPHYLAXIS, ADULT $22.80 19990701 99999999 01112 ANESTHESIA FOR BONE MARROW ASPIRATION AND/OR BIOPSY, ANTERIOR OR POSTERIOR ILIAC $22.80 20010101 99999999 01120 PROPHYLAXIS-CHILD $22.80 19990701 99999999 01130 ANESTHESIA FOR BODY CAST APPLICATION OR REVISION $22.80 19990701 99999999 01140 ANESTHESIA FOR INTERPELVIABDOMINAL (HINDQUARTER) AMPUTATION $22.80 19990701 99999999 01150 ANESTHESIA FOR RADICAL PROCEDURES FOR TUMOR OF PELVIS, EXCEPT HINDQUARTER AMPUTA $22.80 19990701 99999999 01160 ANESTHESIA FOR CLOSED PROCEDURES INVOLVING SYMPHYSIS PUBIS OR SACROILIAC JOINT $22.80 19990701 99999999 01170 ANESTHESIA FOR OPEN PROCEDURES INVOLVING SYMPHYSIS PUBIS OR SACROILIAC JOINT $22.80 19990701 99999999 01173 ANESTHESIA FOR OPEN REPAIR OF FRACTURE DISRUPTION OF PELVIS OR COLUMN FRACTURE $22.80 20040101 99999999 01180 ANESTHESIA FOR OBTURATOR NEURECTOMY; EXTRAPELVIC $22.80 19990701 99999999 01190 ANESTHESIA FOR OBTURATOR NEURECTOMY; INTRAPELVIC $22.80 19990701 99999999 01200 ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING HIP JOINT $22.80 19990701 99999999 01202 TOPICL APPLCTN FLUORIDE (INCL PROPHYLAXIS) ADULT $22.80 19990701 99999999 01210 TOPICAL APP SODIUM FLUORIDE $22.80 19990701 99999999 01212 ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; HIP DISARTICULATION $22.80 19990701 99999999 01214 ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; TOTAL HIP REPLACEMENT OR REV $22.80 19990701 99999999 01215 ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; REVISION OF TOTAL HIP ARTHRO $22.80 20010101 99999999 01220 TOPICAL AYGS STANNOUS FLRIDE- TREATMNT (EXCLDING P $22.80 19990701 99999999 01230 TOPICAL APP ACID FLRIDE PHSPHATE ONE TRM (EX-PROHY $22.80 19990701 99999999 01232 ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; AMPUTATION $22.80 19990701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 88
PROC-CODE DESC MAC BEG END 01234 ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; RADICAL RESECTION $22.80 19990701 99999999 01240 ANESTHESIA FOR ALL PROCEDURES ON INTEGUMENTARY SYSTEM OF UPPER LEG $22.80 19990701 99999999 01250 ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF $22.80 19990701 99999999 01260 ANESTHESIA FOR ALL PROCEDURES INVOLVING VEINS OF UPPER LEG, INCLUDING EXPLORATIO $22.80 19990701 99999999 01270 ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS GRAF $22.80 19990701 99999999 01272 ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS GRAF $22.80 19990701 99999999 01274 ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS GRAF $22.80 19990701 99999999 01300 ANESTHESIA FOR ALL PROCEDURES ON INTEGUMENTARY SYSTEM OF KNEE AND/OR POPLITEAL A $22.80 19990701 99999999 01320 ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF $22.80 19990701 99999999 01340 TRAINING IN PREVENTIVE DENTAL CARE $22.80 19990701 99999999 01360 ANESTHESIA FOR ALL OPEN PROCEDURES ON LOWER 1/3 OF FEMUR $22.80 19990701 99999999 01380 ANESTHESIA FOR ALL CLOSED PROCEDURES ON KNEE JOINT $22.80 19990701 99999999 01382 001STHESIA FOR ARTHROSCOPIC PROCEDURES OF KNEE JOINT $22.80 19990701 99999999 01390 ANESTHESIA FOR ALL CLOSED PROCEDURES ON UPPER ENDS OF TIBIA, FIBULA, AND/OR PATE $22.80 19990701 99999999 01392 ANESTHESIA FOR ALL OPEN PROCEDURES ON UPPER ENDS OF TIBIA, FIBULA, AND/OR PATELL $22.80 19990701 99999999 01400 ANESTHESIA FOR OPEN PROCEDURES ON KNEE JOINT; NOT OTHERWISE SPECIFIED $22.80 19990701 99999999 01402 ANESTHESIA FOR OPEN PROCEDURES ON KNEE JOINT; TOTAL KNEE REPLACEMENT $22.80 19990701 99999999 01404 ANESTHESIA FOR OPEN PROCEDURES ON KNEE JOINT; DISARTICULATION AT KNEE $22.80 19990701 99999999 01420 ANESTHESIA FOR ALL CAST APPLICATIONS, REMOVAL, OR REPAIR INVOLVING KNEE JOINT $22.80 19990701 99999999 01430 ANESTHESIA FOR PROCEDURES ON VEINS OF KNEE AND POPLITEAL AREA; NOT OTHERWISE SPE $22.80 19990701 99999999 01432 ANESTHESIA FOR PROCEDURES ON VEINS OF KNEE AND POPLITEAL AREA; ARTERIOVENOUS FIS $22.80 19990701 99999999 01440 ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; NOT OTHERWISE $22.80 19990701 99999999 01442 ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; POPLITEAL THRO $22.80 19990701 99999999 01444 ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; POPLITEAL EXCI $22.80 19990701 99999999 0146T COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF CORONARY ARTERIES (INCLUDING NATIVE AND ANOM $530.39 20060101 99999999 01460 ANESTHESIA FOR ALL PROCEDURES ON INTEGUMENTARY SYSTEM OF LOWER LEG, ANKLE, AND F $22.80 19990701 99999999 01462 ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER LEG, ANKLE, AND FOOT $22.80 19990701 99999999 01464 ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF ANKLE JOINT $22.80 19990701 99999999 01470 ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG, $22.80 19990701 99999999 01472 ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG, $22.80 19990701 99999999 01474 ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG, $22.80 19990701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 89
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Medicaid Fee Schedule without Mods 200801

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