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Medicare Physician Fee Schedule Effective Locality 01212-01 CMS RVU26D Updated

CPT 92012 Medicare rate in Honolulu, HI

Established patient eye examination, intermediate in ZIPs including 96815, 96813, and 96814

Locality-adjusted allowed amount
$98.15

Honolulu, HI flag Honolulu, HI (Locality 01212-01)

8.4% above the national baseline ($90.52)

CMS evidence · Q4 2026 release

Participating provider, no modifiers, whole service, before sequestration. Change these

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The Medicare allowed amount is $98.15 in the Office (non-facility) setting and $42.32 in a facility, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.

What Medicare locality is Honolulu, HI in? Copy link

CMS prices all of Hawaii as one Medicare payment locality (Hawaii, Guam), so this amount applies statewide, including Hilo, Kailua and Guam—not only in Honolulu, HI.

Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.

ZIP codes in this payment locality (176)

The CMS ZIP-to-locality crosswalk maps 176 ZIP codes to this payment locality, across AS, FM, GU, HI, MH, MP, PW. Use this amount only after you confirm the service location is in this locality.

96701 96703 96704 96705 96706 96707 96708 96709 96710 96712 96713 96714 96715 96716 96717 96718 96719 96720 96721 96722 96725 96726 96727 96728 96729 96730 96731 96732 96733 96734 96737 96738 96739 96740 96741 96742 96743 96744 96745 96746 96747 96748 96749 96750 96751 96752 96753 96754 96755 96756 96757 96759 96760 96761 96762 96763 96764 96765 96766 96767 96768 96769 96770 96771 96772 96773 96774 96775 96776 96777 96778 96779 96780 96781 96782 96783 96784 96785 96786 96788 96789 96790 96791 96792 96793 96795 96796 96797 96799 96801 96802 96803 96804 96805 96806 96807 96808 96809 96810 96811

76 more ZIP codes map to this locality. The Honolulu, HI locality page lists the full set.

Which ZIP codes does the Honolulu, HI rate for 92012 cover?

The CMS ZIP-to-locality crosswalk maps 176 ZIP codes to this payment locality, and 92012 has the same amount in every one of them. Examples include 96701, 96703, 96704, 96705, 96706, 96707. The locality spans AS, FM, GU, HI, MH, MP, PW.

Does this 92012 rate apply everywhere in Hawaii?

Yes. CMS prices Hawaii as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Honolulu, HI. That includes Hilo, Kailua and Guam. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.

How the Honolulu, HI amount is calculated Copy link

How locality affects the amount Copy link

Office (non-facility) · Q4 2026 · Participating · Whole service

Honolulu, HI's $98.15 compares with the $90.52 national PFS baseline (GPCI 1.000). Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Honolulu, HI 8.4% above the national baseline.

Honolulu, HI ranks #24 of 109 Medicare payment localities for 92012, where #1 has the highest allowed amount.

Work GPCI
1.000
$0.00 vs. national
Practice expense GPCI
1.137
+$8.05 vs. national
Malpractice GPCI
0.579
−$0.42 vs. national
2026 conversion factor
$33.4009

Each figure is that GPCI's share of the +$7.63 gap from the national baseline: its RVUs for 92012 × (GPCI − 1.000) × the conversion factor. Practice expense accounts for the most, +$8.05.

CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows

Show the full calculation and CMS rows

For the office (non-facility) amount, each of 92012's RVU components is multiplied by its Honolulu, HI GPCI; the products are summed and multiplied by the conversion factor.

Code
92012
DOS
Not selected; uses this release’s rates
Locality
Hawaii, Guam (01212-01)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q4 2026, revision 2
Sequestration
Shown separately from the allowed amount

Formula

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from.

RVU × GPCI components of Honolulu, HI allowed amount for 92012
Component RVU × GPCI = Adjusted
Work 0.92 × 1.000 0.9200
Practice expense · Office (non-facility) 1.76 × 1.137 2.0011
Malpractice 0.03 × 0.579 0.0174
Sum of adjusted RVUs 2.9385
× 33.4009 conversion factor = formula amount $98.15

Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.

  1. Locality-adjusted allowed amount $98.15

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • 92012’s RVUs, PFS status and conversion factor

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

    PPRRVU2026_Oct_nonQPP.csv row 11,661 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    92012
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    0.92
    G Non-facility PE RVU
    1.76
    K MP RVU
    0.03
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 11,659–11,663 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

  • Locality 01212-01’s GPCIs

    Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2

    GPCI2026.csv row 46 in rvu26d-updated-08-26-2026.zip

    A MAC
    01212
    C Locality number
    01
    E Work GPCI
    1.000
    F PE GPCI
    1.137
    G MP GPCI
    0.579
    In the CMS file

    Loading rows 44–48 of GPCI2026.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

Why is the 92012 rate in Honolulu, HI different from the national amount?

The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices—work 1.000, practice expense 1.137, malpractice 0.579—scale each RVU component before the conversion factor is applied, which is why the Honolulu, HI amount is higher than the $90.52 baseline.

92012 in Honolulu, HI since Q4 2025 Copy link

Office (non-facility) · Participating · Whole service

The allowed amount went from $93.11 in Q4 2025 to $98.15 in Q4 2026, +$5.04 (+5.4%). The national baseline moved +6.0% over the same period.

What changed 92012's allowed amount in Honolulu, HI between Q4 2025 and Q4 2026
What moved Effect
Conversion factor National: the dollar multiplier CMS sets each year. +$3.04
92012's RVUs National: CMS revalued the code itself. +$2.69
Honolulu, HI's GPCIs Local: this payment locality's cost indices. −$0.69
Total change +$5.04

A derived breakdown of the two releases' formula inputs, applied in order: the conversion factor on Q4 2025's RVUs and GPCIs, then 92012's new RVUs, then this locality's new GPCIs. A different order moves a few cents between rows; the total is exact.

Which amount applies to your claim? Copy link

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 92012 in Honolulu, HI is $42.32, versus $98.15 in the Office (non-facility) setting. Only the practice-expense RVU changes with the setting: the facility bills its own fee for overhead, so the professional amount is lower. See which setting applies to your place of service.

What is the Facility amount for 92012 in Honolulu, HI?

$42.32 in a facility, versus $98.15 in the Office (non-facility) setting—a $55.83 difference. Only the practice-expense RVU changes with the setting: in the Office (non-facility) setting the practice carries the overhead, so the professional amount is higher; in a hospital or ASC the facility bills its own fee.

Who pays what Copy link

Medicare pays part of the Honolulu, HI allowed amount and the patient pays the rest. A provider who doesn’t participate in Medicare is allowed less, and can bill the patient up to a ceiling.

Computed from the Q4 2026 CMS release

Allowed amount

The fee-schedule amount for 92012 in the Office (non-facility) setting in Honolulu, HI. A participating provider accepts it as payment in full, and every figure below starts from it.

$98.15
Medicare's share

80% of the allowed amount, once the annual Part B deductible is met.

$78.52
Sequestration

The 2% cut to Medicare’s share. It never reduces the allowed amount or the patient’s coinsurance.

-$1.57
What Medicare pays

Medicare’s share after sequestration.

$76.95
Patient coinsurance

The remaining 20%. Medigap or Medicaid often covers it.

$19.63
Non-participating amount

What a provider who doesn’t participate in Medicare is allowed on an assigned claim: 95% of the allowed amount.

$93.24
Limiting charge

The most a non-participating provider can bill the patient on an unassigned claim: 115% of the non-participating amount.

$107.23
What is the non-participating amount and limiting charge for 92012 in Honolulu, HI?

A non-participating provider is paid $93.24—95% of the $98.15 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $107.23, which is 115% of the non-participating amount.

How much of the Honolulu, HI 92012 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($78.52) once the annual Part B deductible is met, and the beneficiary owes 20% ($19.63). Sequestration reduces Medicare's share by about 2% ($1.57), leaving $76.95. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contract rates and comparisons Copy link

Contracted rate: % of Medicare in Honolulu, HI Copy link

Commercial contracts are often written as a percentage of the Medicare fee schedule. The part that gets misread is which Medicare amount: a contract benchmarked to the fee schedule prices off this locality's allowed amount—$98.15 in the office (non-facility) setting—not the $90.52 national baseline.

Opens the calculator set to Honolulu, HI and your selected setting, where you can also compare what a payer paid against the expected amount. See how to find your contract's actual percentage.

92012 in comparable metros Copy link

Metros whose Office (non-facility) amount for 92012 sits closest to Honolulu, HI's, highest first. Each is that payment locality's own GPCI-adjusted amount.

Payment locality Allowed · vs. this page

Percentages are against Honolulu, HI. Every payment locality nationwide is on the CPT 92012 rate map.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q4 2026 release: this code's RVUs from the relative value file, multiplied by payment locality 01212-01's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 2026 release. Past releases are never edited, so an amount for an earlier quarter always matches what CMS published for it. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 11,661)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 46)
ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

Working a claim with an earlier date of service? The calculator prices 92012 in Honolulu, HI against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.

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