Medicare payment locality · Q3 2023 release

Hawaii, Guam HI Medicare Locality 01

MAC 01212 · Locality 01

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q3 2023 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.003

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.146

Adjusts practice-expense inputs such as staff, rent, and services

Malpractice GPCI

0.618

Adjusts the malpractice component using liability-cost data

1.000 is the national baseline. Above raises that component; below lowers it. GPCIs are Medicare payment factors, not general cost-of-living or physician-compensation indexes.

Example rates in Hawaii, Guam Copy link

National vs. Hawaii, Guam office (non-facility) amounts for frequently reviewed codes, Q3 2023 (before sequestration). Conversion factor: 2023 standard (non-QP) physician conversion factor · $33.8872.

Code	National	Hawaii, Guam	Difference
99214	$128.43	$135.37	+5.4%
99213	$90.82	$95.99	+5.7%
99215	$179.94	$189.07	+5.1%
66984	$541.86	$575.51	+6.2%
99204	$167.40	$175.13	+4.6%
92014	$127.08	$138.03	+8.6%
97110	$29.82	$31.81	+6.7%
88305	$71.84	$78.34	+9.0%
97530	$37.61	$40.80	+8.5%
99203	$112.84	$118.52	+5.0%

Need a specific code or a facility rate? Use the rate calculator with this locality selected. Or start from your field's usual procedure mix on the specialty fee schedules.

ZIP codes in this locality Copy link

Hawaii, Guam covers 176 ZIP codes across AS, FM, GU, HI, MH, MP, PW, per the CMS ZIP-to-locality crosswalk (Q2 2022).

The Q3 2023 ZIP-to-locality crosswalk file is not on file here; figures are from the Q2 2022 release and may not reflect Q3 2023 revisions.

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 96812 96813 96814 96815 96816 96817 96818 96819 96820 96821 96822 96823 96824 96825 96826 96827 96828 96830 96835 96836 96837 96838 96839 96840 96841 96842 96843 96844 96845 96846 96847 96848 96849 96850 96853 96854 96857 96858 96859 96860 96861 96862 96863 96898 96910 96911 96912 96913 96914 96915 96916 96917 96918 96919 96921 96922 96923 96925 96926 96927 96928 96929 96930 96931 96932 96939 96940 96941 96942 96943 96944 96950 96951 96952 96960 96970

Not sure which locality your ZIP is in? Look it up by ZIP code.

Common questions Copy link

Why do Medicare rates in Hawaii, Guam differ from the national amount?

For nationally priced Physician Fee Schedule services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs by this locality's three GPCIs before applying the conversion factor. Local professional labor, office-input, and liability costs therefore move the final amount up or down. Hawaii, Guam currently has mixed GPCI components, so the net payment effect varies by code for the Q3 2023 release.

How do I know if my address is in this locality?

Medicare payment localities are geographic fee-schedule areas, commonly defined with county boundaries. CMS uses the service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. A few ZIPs nationally span multiple localities and need ZIP+4 to resolve exactly.

Do commercial insurers or Medicare Advantage plans use this locality?

Original Medicare uses these PFS localities directly. Commercial and Medicare Advantage plans are not required to use the same locality structure. A contract may benchmark payment to Medicare, but its language controls the Medicare release, percentage, geographic basis, and other adjustments.

Does my locality affect what I owe as a patient?

For a particular covered service, a higher locality-adjusted allowed amount generally produces a higher percentage-based coinsurance amount. The effect depends on the code, the beneficiary's deductible, supplemental coverage, and other claim circumstances.

Why did my Medicare payment change even though I didn't change what I billed?

CMS publishes updated PFS files during the year. A code's amount can change because of conversion-factor, RVU, policy, or correction updates. GPCI policy values are generally established through annual rulemaking, although later files can contain corrections. See what changed each release.

Source & method Copy link

GPCIs and rates computed from the CMS Medicare Physician Fee Schedule Q3 2023 release (effective July 2023). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q2 2022 release . Example amounts use the standard (non-QP) physician conversion factor ($33.8872) and apply this locality's GPCIs to nationally priced non-facility RVUs, before the ~2% sequestration cut. Releases are immutable: a rate retrieved for a past quarter always reflects that PFS release.

Geographic practice cost indices (Q3 2023) · rvu23c.zip (GPCI2023.csv row 49)

ZIP code to carrier locality crosswalk (Q2 2022) · Zip-Code-to-Carrier-Locality.zip (ZIP5_APR2022_V2.txt)

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