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Medicare Physician Fee Schedule · Q3 2026 release

CPT 98942 in Honolulu, HI 01212-01

98942 2026 C · Honolulu, HI flag01212-01 A Active
Allowed amount
$52.10
in a doctor’s own office or clinic

104.7% of the $49.77 national baseline

Medicare payment
$41.68
Patient / secondary
$10.42
Expected total to provider
$52.10

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

How much does Medicare allow for CPT 98942 in Honolulu, HI? Copy link

The Medicare allowed amount is $52.10 in the office (non-facility) setting and $38.81 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 4.7% above the national baseline, and the facility amount is 1.9% above the national baseline. 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.

Why Honolulu, HI differs from the national amount Copy link

Honolulu, HI (this locality)
$52.10
National PFS baseline (GPCI 1.000)
$49.77

The national figure is a baseline, not an amount any provider is paid. This locality's geographic practice cost indices scale each RVU component before the conversion factor is applied, which puts Honolulu, HI at 4.7% above the national baseline.

Work GPCI
1.000
Practice expense GPCI
1.137
Malpractice GPCI
0.579
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 98942 in Honolulu, HI: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Honolulu, HI allowed amount for 98942
Component RVU × GPCI = Adjusted RVU
Work 0.94 1.000 0.9400
Practice expense 0.54 1.137 0.6140
Malpractice 0.01 0.579 0.0058
Sum of adjusted RVUs 1.5598
× $33.4009 2026 conversion factor $52.10

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Honolulu, HI allows $38.81 for 98942, versus $52.10 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Honolulu, HI. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 98942 in Honolulu, HI
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $52.10
Non-participating allowed amount 95% of the participating amount. $49.50
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $56.93
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $41.68
Beneficiary coinsurance The remaining 20%. $10.42
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $0.83
Medicare pays after sequestration Program payment net of the sequestration reduction. $40.85

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

Commercial contracts are usually written as a percentage of the Medicare fee schedule. Which Medicare amount they mean is the part that gets misread: a contract benchmarked to the fee schedule prices off this locality's allowed amount — $52.10 in the office (non-facility) setting — not the $49.77 national baseline.

Opens the calculator already set to Honolulu, HI and the office (non-facility) setting. It also compares what a payer actually paid against the expected amount. See how to find your contract's actual percentage.

ZIP codes this Honolulu, HI rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 176 ZIP codes to this payment locality, across AS, FM, GU, HI, MH, MP, PW. 98942 prices identically in every one of them.

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.

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

98942 in comparable metros Copy link

Metros whose office (non-facility) amount for 98942 sits closest to Honolulu, HI's, highest first. Each is that payment locality's own GPCI-adjusted amount.

98942 allowed amount in metros comparable to Honolulu, HI
Metro Allowed amount vs. Honolulu, HI
Portland, OR $52.19 +0.2%
Riverside, CA $52.01 -0.2%
Bakersfield, CA $51.96 -0.3%
Fresno, CA $51.88 -0.4%
Hartford, CT $51.85 -0.5%
Baltimore, MD $51.67 -0.8%
Denver, CO $51.23 -1.7%
Philadelphia, PA $51.14 -1.8%
Miami, FL $51.02 -2.1%
Providence, RI $50.92 -2.3%
Austin, TX $50.84 -2.4%
Suburban Chicago, IL $50.73 -2.6%

Every payment locality nationwide is on the CPT 98942 rate map.

Other codes priced in Honolulu, HI Copy link

Office (non-facility) allowed amounts in this same payment locality, Q3 2026.

Other curated codes and their allowed amounts in Honolulu, HI
Code Service Honolulu, HI vs. national
98941 Chiropractic Spinal Manipulation, Multiple Regions $40.33 +5.0%
98940 Chiropractic Spinal Manipulation $28.14 +5.3%
99213 Routine Follow-Up Office Visit $100.61 +5.7%
99214 Long Follow-Up Office Visit $142.79 +5.3%
66984 Cataract Surgery $483.11 +4.4%
92014 Full Eye Exam, Returning Patient $137.45 +8.0%
99204 Long New Patient Office Visit $185.29 +4.5%
99212 Brief Follow-Up Office Visit $63.28 +6.4%
99215 Longest Follow-Up Office Visit $202.02 +5.0%
97110 Physical Therapy Exercises $30.79 +6.0%
99203 New Patient Office Visit $123.37 +4.9%
93010 Heart Tracing Reading $8.53 +2.2%

Common questions Copy link

Which ZIP codes does the Honolulu, HI rate for 98942 cover?
The CMS ZIP-to-locality crosswalk maps 176 ZIP codes to this payment locality, and every one of them prices 98942 identically. Examples include 96701, 96703, 96704, 96705, 96706, 96707. The locality spans AS, FM, GU, HI, MH, MP, PW.
Why is the 98942 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 Honolulu, HI allows more than the $49.77 baseline.
Does this 98942 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.
What is the facility rate for 98942 in Honolulu, HI?
$38.81 in a facility, versus $52.10 in the office (non-facility) setting — a $13.29 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 98942 in Honolulu, HI?
A non-participating provider is paid $49.50 — 95% of the $52.10 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $56.93, which is 115% of the non-participating amount.
How much of the Honolulu, HI 98942 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($41.68) once the annual Part B deductible is met, and the beneficiary owes 20% ($10.42). Sequestration reduces Medicare's share by about 2% ($0.83), leaving $40.85. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q3 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, Q3 2026 release . Releases are immutable: an amount retrieved for a past quarter always reflects that PFS release. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 12,883)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 46)
ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Working a claim with an earlier date of service? The calculator prices 98942 in Honolulu, HI against the release that governed that date. The last 12 months price without an account; older dates of service need a free account.

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