Office Visit (Established, Moderate-High) Cost in Hawaii
Office o/p est mod 30 min
$136.12Hawaii physician fee2026 Medicare office rate- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
Hawaii Medicare physician rate (2026)
+0.4% vs nationalSingle statewide locality.
Your ZIP in Hawaii
Enter your ZIP code for Hawaii figures, whether you live on Oahu, in Hilo or Kona on the Big Island, or on Maui or Kauai where a Honolulu trip is often part of the plan.
What office visit (established, moderate-high) costs at hospitals near you
Everything above is a national average. The hospital you pick in Hawaii moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. In Hawaii the office and hospital physician lines for this CPT differ by $51.10.
National vs Hawaii
Where Hawaii ranks for this CPT
Office Visit (Established, Moderate-High) and how Hawaii is priced
Hawaii is priced through a single locality with geographic adjustments well above the mainland norm, driven largely by the practice expense side: rent, staff wages, and supplies all cost more across the islands. Unlike Alaska, Hawaii does not carry a special statutory floor, but its indices still place it among the higher-cost states in the fee schedule. Every island shares the same locality, so Honolulu and Hilo publish the same Medicare-approved amounts. The real variable for residents is which island the care is on, not the rate itself.
Oahu holds the bulk of Hawaii's hospital capacity and nearly all of its subspecialty care, so neighbor island residents routinely fly to Honolulu for procedures, adding airfare and hotel costs to the medical bill. A small number of systems dominate the market, and physician recruitment to the islands is a chronic challenge. For complex or rare conditions, some patients travel on to the mainland West Coast.
This procedure: This is an established-patient office visit of moderate complexity, a step above the routine check-in: managing multiple chronic conditions at once, adjusting medications with real risk, or evaluating a new problem that needs a workup. Billed by time it represents 30 to 39 minutes on the visit date. Over the last decade it has overtaken the level-three visit as the most common established-patient code in primary care, reflecting more complex visits and better documentation.
What Is Office Visit (Established, Moderate-High)?
This is an established-patient office visit of moderate complexity, a step above the routine check-in: managing multiple chronic conditions at once, adjusting medications with real risk, or evaluating a new problem that needs a workup. Billed by time it represents 30 to 39 minutes on the visit date. Over the last decade it has overtaken the level-three visit as the most common established-patient code in primary care, reflecting more complex visits and better documentation.
What Affects the Cost
- –It reimburses meaningfully more than 99213, and which of the two your visit becomes depends on documented complexity you cannot see from the waiting room.
- –Multi-condition patients land here repeatedly through the year, compounding the higher per-visit rate.
- –Facility fees at hospital-owned practices add a second charge to every visit at any level.
- –In-office tests, injections, or procedures stack as separate lines.
- –Specialist follow-ups at this level are priced above primary care equivalents in most charge masters.
Questions to Ask Before Booking
- 1.What determines whether my visit bills as level three or four, and what is the price difference for me?
- 2.During my deductible phase, what is the negotiated rate for this level here?
- 3.Will medication changes today push the visit to a higher level?
- 4.Are any of today's services billed separately from the visit code?
- 5.Can complex medication reviews be split across telehealth check-ins at lower cost?
Other featured procedures in Hawaii
Office Visit (Established, Moderate-High) in other states
Office Visit (Established, Moderate-High) in Hawaii: questions
Hawaii is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 99214 is $136.12 in an office and $85.02 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. Hawaii uses one locality, so the Medicare physician rate is the same from one end of the state to the other. What still changes is site of service (office vs hospital) and any facility fee the hospital bills on its own claim.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $27 for the office physician line or $17 for the hospital physician line in Hawaii. Medigap may cover that 20%. This is not the hospital facility fee.
No. $136.12 is the Medicare physician allowed amount for CPT 99214. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Hawaii ranks #36 of 51 states on this physician line (within 2% of the national office rate of $135.61).