Hawaii Medicaid reimbursement rates
17,383 current fee-for-service and managed-care rates from Hawaii Medicaid, across 98 services and 12 programs, normalized by code, provider level and unit. Each links to one of 37 official source documents.
Last retrieved 2026-10-05. History back to 2011-01-01.
- Current rates
- 17,383
- Services
- 98
- Programs
- 12
- Lines with a plan rule
- 8of 22 service lines
By industry
Applied behavior analysis (ABA)Hawaii rates, labor costs and changesBehavioral healthHawaii rates, labor costs and changesHome healthHawaii rates, labor costs and changesHome care & personal careHawaii rates, labor costs and changesPrivate duty nursingHawaii rates, labor costs and changesSkilled nursing facilitiesHawaii rates, labor costs and changesHospiceHawaii rates, labor costs and changesIntellectual & developmental disabilitiesHawaii rates, labor costs and changesOutpatient therapy (PT, OT, speech)Hawaii rates, labor costs and changes
Hawaii rates by service
The median current rate for each service, like-for-like by unit. Follow a service to compare it with every other state.
| Service | Line | Median rate | Unit | Per hour | Variants |
|---|---|---|---|---|---|
| ABA assessment by a behavior analyst | ABA / autism services | $30.33 | 15 min | $121.30 | 2 |
| ABA assessment support by a technician | ABA / autism services | $20.24 | 15 min | $80.96 | 2 |
| ABA assessment with 2+ technicians (severe behavior) | ABA / autism services | $54.71 | 15 min | $218.84 | 2 |
| ABA parent and caregiver training | ABA / autism services | $25.01 | 15 min | $100.04 | 3 |
| ABA therapy with 2+ technicians (severe behavior) | ABA / autism services | $28.09 | 15 min | $112.36 | 4 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $35.94 | 15 min | $143.76 | 3 |
| Group ABA parent training (several families) | ABA / autism services | $13.74 | 15 min | $99.44 | 11 |
| Group ABA therapy led by a technician | ABA / autism services | $7.89 | 15 min | $50.32 | 6 |
| Group ABA therapy led by an analyst | ABA / autism services | $15.60 | 15 min | $99.44 | 6 |
| One-on-one ABA therapy by a technician | ABA / autism services | $17.66 | 15 min | $70.64 | 4 |
| Behavioral health services (fee schedule) | Behavioral health | $24.00 | — | — | 1 |
| Medication administration (behavioral health) | Behavioral health | $200.00 | visit | — | 4 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $85.51 | — | $130.97 | 22 |
| FQHC / RHC visit (PPS or APM rate) | Clinics (FQHC/RHC) | $411.67 | visit | — | 43 |
| FQHC dental visit (PPS or APM rate) | Clinics (FQHC/RHC) | $358.65 | visit | — | 15 |
| FQHC/RHC payment method parameter | Clinics (FQHC/RHC) | $26.50 | % | — | 2 |
| Dental payment adjustment (percent of the fee schedule) | Dental | $62.50 | % of the average code average of the 2 major commercial dental plans for Oahu (previous 12 months) | — | 2 |
| Dental services | Dental | $145.60 | — | — | 1758 |
| Durable medical equipment | Equipment & supplies | $39.57 | — | $96.84 | 93 |
| Enteral and parenteral nutrition | Equipment & supplies | $11.41 | — | — | 40 |
| Medical supplies | Equipment & supplies | $11.44 | — | — | 497 |
| Orthotics and prosthetics | Equipment & supplies | $594.47 | — | $182.92 | 865 |
| Adult day health (medical model) | Other home & community services | $43.61 | 15 min | $69.48 | 3 |
| Adult day services | Other home & community services | $63.06 | day | — | 1 |
| Adult foster care | Other home & community services | $71.82 | day | — | 16 |
| Assisted living / alternative living services | Other home & community services | $201.06 | day | — | 8 |
| Assistive technology support (training and set-up) | Other home & community services | $1.00 | Per Service Unit | — | 2 |
| Automated medication dispenser monthly service | Other home & community services | $87.32 | month | — | 1 |
| Case management / support coordination | Other home & community services | $84.00 | — | $1,344.00 | 5 |
| Emergency response system installation | Other home & community services | $65.00 | — | — | 4 |
| Emergency response system monitoring | Other home & community services | $43.00 | month | — | 3 |
| Food benefit / produce prescription (HRSN nutrition support) | Other home & community services | $64.00 | per week | — | 6 |
| Home modifications (accessibility) | Other home & community services | $1.00 | Per Service Unit | — | 4 |
| Home-delivered meals | Other home & community services | $10.50 | meal | — | 1 |
| Interpreter services | Other home & community services | $9.36 | 15 min | $37.44 | 1 |
| Specialized medical equipment and supplies | Other home & community services | $1.00 | — | — | 5 |
| Supportive housing and housing transition supports | Other home & community services | $275.00 | per member per month | — | 4 |
| Transitional care coordination (children's waiver) | Other home & community services | $175.00 | per completed intake and care plan | $112.00 | 3 |
| Vehicle modifications | Other home & community services | $1.00 | Per Service Unit | — | 4 |
| Home health aide visit | Home health | $20.00 | visit | — | 1 |
| Home health payment method rule | Home health | $80.00 | % of Medicare Fee Schedule (prior calendar year) | — | 2 |
| Hospice payment method rule | Hospice | $95.00 | % | — | 3 |
| Hospice room and board in a nursing home | Hospice | $479.45 | day | — | 44 |
| Hospital administrative (non-acute) day | Hospital inpatient | $486.44 | day | — | 24 |
| Inpatient ancillary payment per discharge (per-diem hospitals) | Hospital inpatient | $2,366.99 | discharge | — | 40 |
| Inpatient DRG pricing input (outlier, cost ratio, stay) | Hospital inpatient | $2.70 | day | — | 2011 |
| Inpatient DRG relative weight | Hospital inpatient | $1.13 | weight | — | 1320 |
| Inpatient hospital payment method | Hospital inpatient | $65.00 | % | — | 6 |
| Inpatient hospital stay (DRG base rate) | Hospital inpatient | $11,578.24 | discharge | — | 28 |
| Inpatient hospital stay (per diem) | Hospital inpatient | $1,168.68 | day | — | 77 |
| Inpatient payment adjustment factor | Hospital inpatient | $0.0056 | ime_factor | — | 14 |
| Inpatient psychiatric stay (per day) | Hospital inpatient | $1,204.39 | day | — | 22 |
| Outpatient hospital payment method | Hospital outpatient | $75.00 | % | — | 4 |
| Community integration / community access (IDD) | IDD services | $20.62 | 15 min | $82.48 | 4 |
| Consultative clinical assessment (IDD) | IDD services | $175.80 | hour | $175.80 | 7 |
| Crisis intervention for people with I/DD (waiver) | IDD services | $551.25 | 15 min | $210.00 | 4 |
| Intensive behavioral residential supports | IDD services | $29.80 | 15 min | $119.20 | 1 |
| Residential habilitation / group home supports | IDD services | $175.06 | day | — | 6 |
| Clinical lab tests | Lab & pathology | $30.02 | — | — | 1904 |
| Adult subacute nursing care (daily rate) | Nursing facility | $846.35 | day | — | 14 |
| Nursing home statewide price component | Nursing facility | $127.77 | day | — | 4 |
| Nursing home stay (daily rate) | Nursing facility | $504.57 | day | $119.00 | 43 |
| Community palliative care (bundled care management and assessments) | Other | $512.50 | month | — | 4 |
| Directed payment: plan payment level (% of benchmark) | Other | $61.74 | % of Average Commercial Rates | — | 12 |
| Directed payment: required minimum or maximum level | Other | $85.00 | % of prevailing Medicare RBRVS professional fee (in effect Dec 31 of prior year) | — | 3 |
| Medical respite (recuperative care) for people experiencing homelessness, daily | Other | $274.00 | per member per day | — | 8 |
| Companion care | Personal care & attendant | $9.00 | hour | $15.00 | 2 |
| Home health aide or nurse aide care (hourly) | Personal care & attendant | $17.40 | hour | $22.72 | 3 |
| Homemaker / housekeeping help | Personal care & attendant | $9.32 | hour | $16.00 | 3 |
| Personal care / attendant care (hourly) | Personal care & attendant | $23.49 | 15 min | $93.36 | 10 |
| Pharmacy dispensing fee | Pharmacy | $10.76 | prescription | — | 1 |
| Physician-administered drugs (J-codes) | Pharmacy | $49.29 | — | — | 12 |
| Vaccines and immune globulins | Pharmacy | $59.00 | administration | — | 2 |
| Private duty nursing (hourly shifts) | Private duty nursing | $22.66 | Per 15 minutes / per visit | $77.02 | 6 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $28.98 | 15 min | $108.82 | 5 |
| Payment percentage for non-physician practitioners | Physician & professional | $80.00 | % of prevailing Hawaii Medicare professional fee | — | 6 |
| Physician and practitioner services (fee schedule) | Physician & professional | $413.96 | — | $103.95 | 7451 |
| Practitioner payment adjustment (percent or set amount) | Physician & professional | $24.00 | % of Medicare Fee Schedule (prior calendar year) | — | 11 |
| Imaging and radiology | Radiology | $85.64 | — | — | 630 |
| Cognitive rehabilitation therapy | Therapy (PT/OT/speech) | $21.61 | 15 min | $86.42 | 2 |
| Nutrition counseling (dietitian) | Therapy (PT/OT/speech) | $30.51 | 30 min | $109.52 | 4 |
| Occupational therapy | Therapy (PT/OT/speech) | $52.23 | 15 min | $208.92 | 2 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $107.40 | — | — | 4 |
| Orthotic and prosthetic fitting and training | Therapy (PT/OT/speech) | $55.10 | 15 min | $200.72 | 5 |
| Physical therapy | Therapy (PT/OT/speech) | $32.46 | 15 min | $129.82 | 2 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $104.43 | — | — | 4 |
| Speech-generating device evaluation | Therapy (PT/OT/speech) | $129.32 | — | — | 1 |
| Speech-generating device therapy | Therapy (PT/OT/speech) | $107.97 | — | — | 1 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $126.44 | — | — | 4 |
| Speech-language therapy | Therapy (PT/OT/speech) | $79.39 | — | — | 1 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $72.14 | — | — | 1 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $88.12 | — | — | 1 |
| Air ambulance transport | Transportation | $8,412.52 | — | — | 18 |
| Ambulance mileage | Transportation | $1.95 | mile | — | 1 |
| Ground ambulance transport | Transportation | $245.70 | — | — | 3 |
| Non-emergency medical transportation (NEMT) | Transportation | $5.25 | — | — | 9 |
| Eyeglasses and contact lenses | Vision & hearing | $102.32 | — | — | 102 |
| Hearing aids and hearing services | Vision & hearing | $111.03 | — | — | 10 |
Most-compared billing codes in Hawaii
Where Hawaii ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | Hawaii | All-state median | Rank |
|---|---|---|---|---|
| 10005 | Physician and practitioner services (fee schedule) | $70.57 | $85.55 | 32 of 48 |
| 10006 | Physician and practitioner services (fee schedule) | $48.28 | $45.64 | 18 of 48 |
| 10007 | Physician and practitioner services (fee schedule) | $85.76 | $186.96 | 33 of 48 |
| 10008 | Physician and practitioner services (fee schedule) | $48.88 | $92.51 | 37 of 48 |
| 10009 | Physician and practitioner services (fee schedule) | $104.23 | $273.41 | 34 of 48 |
| 10010 | Physician and practitioner services (fee schedule) | $67.96 | $153.30 | 38 of 48 |
| 10021 | Physician and practitioner services (fee schedule) | $53.51 | $71.68 | 32 of 48 |
| 10030 | Physician and practitioner services (fee schedule) | $129.52 | $382.62 | 33 of 48 |
| 10060 | Physician and practitioner services (fee schedule) | $112.07 | $88.74 | 8 of 48 |
| 10061 | Physician and practitioner services (fee schedule) | $189.13 | $153.30 | 10 of 48 |
| 10080 | Physician and practitioner services (fee schedule) | $108.88 | $129.47 | 27 of 48 |
| 10081 | Physician and practitioner services (fee schedule) | $170.96 | $200.51 | 28 of 48 |
| 10120 | Physician and practitioner services (fee schedule) | $110.20 | $98.41 | 20 of 48 |
| 10121 | Physician and practitioner services (fee schedule) | $185.65 | $171.22 | 23 of 48 |
| 10140 | Physician and practitioner services (fee schedule) | $122.19 | $109.79 | 20 of 48 |
| 10160 | Physician and practitioner services (fee schedule) | $99.83 | $86.10 | 20 of 48 |
| 10180 | Physician and practitioner services (fee schedule) | $181.21 | $181.20 | 24 of 48 |
| 11000 | Physician and practitioner services (fee schedule) | $26.08 | $37.55 | 36 of 48 |
| 11001 | Physician and practitioner services (fee schedule) | $14.34 | $17.78 | 32 of 48 |
| 11004 | Physician and practitioner services (fee schedule) | $537.25 | $437.24 | 7 of 48 |
| 11005 | Physician and practitioner services (fee schedule) | $722.65 | $593.30 | 7 of 48 |
| 11006 | Physician and practitioner services (fee schedule) | $660.38 | $545.22 | 8 of 48 |
| 11008 | Physician and practitioner services (fee schedule) | $253.92 | $210.47 | 8 of 48 |
| 11010 | Physician and practitioner services (fee schedule) | $275.32 | $279.22 | 27 of 48 |
| 11011 | Physician and practitioner services (fee schedule) | $291.12 | $321.34 | 29 of 48 |
| 11012 | Physician and practitioner services (fee schedule) | $405.43 | $431.82 | 28 of 48 |
| 11042 | Physician and practitioner services (fee schedule) | $60.30 | $82.72 | 32 of 48 |
| 11043 | Physician and practitioner services (fee schedule) | $150.71 | $165.09 | 33 of 48 |
| 11044 | Physician and practitioner services (fee schedule) | $218.19 | $227.02 | 26 of 48 |
| 11055 | Physician and practitioner services (fee schedule) | $14.84 | $38.32 | 36 of 48 |
| 11056 | Physician and practitioner services (fee schedule) | $21.36 | $45.25 | 36 of 48 |
| 11057 | Physician and practitioner services (fee schedule) | $27.33 | $50.83 | 34 of 48 |
| 11102 | Physician and practitioner services (fee schedule) | $37.30 | $70.00 | 36 of 48 |
| 11103 | Physician and practitioner services (fee schedule) | $21.57 | $36.04 | 35 of 48 |
| 11104 | Physician and practitioner services (fee schedule) | $46.13 | $82.45 | 36 of 48 |
| 11105 | Physician and practitioner services (fee schedule) | $24.94 | $42.01 | 36 of 48 |
| 11106 | Physician and practitioner services (fee schedule) | $55.47 | $100.59 | 36 of 48 |
| 11107 | Physician and practitioner services (fee schedule) | $30.08 | $48.97 | 36 of 48 |
| 11300 | Physician and practitioner services (fee schedule) | $33.50 | $49.39 | 32 of 48 |
| 11301 | Physician and practitioner services (fee schedule) | $51.00 | $63.36 | 31 of 48 |
Managed care in Hawaii
9 plans on record, 15 state-directed payment records.
Who sets the rate, line by line →Recent rate changes and notices
Frequently asked questions
Where does Hawaii publish its Medicaid fee schedules?
Hawaii publishes rates across 37 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does Hawaii publish?
17,383 rates are current across 98 services and 12 programs, with 49,910 versions on record since 2011-01-01.
Do Hawaii Medicaid managed-care plans pay the fee schedule?
For 8 of 22 service lines, plan contracts or state law set a rule plans must follow (a floor, a state-set rate or a required pass-through). For the rest, plans negotiate. See the managed-care page for each line's rule and citation.
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Your Hawaii rate cardYour codes, what Hawaii pays, what plans must pay, and every change in 2026.