Therapy Medicaid rates in Hawaii are in the national top ten on every service. Hawaii Med-QUEST pays $122.88 an hour for physical therapy under code 97110, which ranks 6th of 49 states and is 27.9% above the national median of $96.04. The rate is $30.72 per 15-minute unit, effective 2026-06-01.
What makes Hawaii distinctive is breadth. Several states pay more for one discipline, but Hawaii ranks between 6th and 8th on all six therapy services at once, and it pairs that with therapist wages close to the national medians. The result is wide therapy margins across every discipline. All rates are compiled from official Hawaii Med-QUEST publications, and the Hawaii Medicaid rates hub links each to its source document.
All six Hawaii rates share the same effective date, 2026-06-01.
| Service | Code | Hawaii rate | Rank | vs national median |
|---|---|---|---|---|
| Physical therapy | 97110 | $122.88/hour | 6 of 49 | +27.9% |
| Occupational therapy | 97530 | $149.84/hour | 8 of 48 | +35.5% |
| Speech-language therapy | 92507 | $79.39 | 6 of 39 | +28.8% |
| PT evaluation | 97161 | $104.43 | 7 of 46 | +27.8% |
| OT evaluation | 97165 | $107.40 | 6 of 46 | +30.3% |
| Speech-language evaluation | 92522 | $114.48 | 8 of 44 | +25.4% |
Every rate falls between 25.4% and 35.5% above its national median. Occupational therapy, at $149.84 an hour, is the strongest relative to the median. For a practice, that consistency means the Hawaii schedule rewards a mixed PT, OT and speech caseload without penalizing any one discipline.
Hawaii publishes its therapy rates in the Med-QUEST fee-for-service fee schedule, issued as dated editions. The current therapy rates come from the edition as of 2026-06-01, which is why every service in the table carries the same date. Every therapy claim with a date of service from June 2026 onward should price against that edition, so remittances that come back below these figures are easy to spot.
Units and per-service codes
Physical and occupational therapy treatment codes such as 97110 and 97530 are timed codes billed in 15-minute units; four units make the hourly figures used for comparison. Speech therapy under 92507 and the evaluation codes are priced per service. That difference matters for scheduling: extending a PT or OT session adds units and revenue, while extending a speech session or evaluation does not.
In many states, one discipline is the obvious money-maker and another loses money on Medicaid. Hawaii does not force that choice. PT, OT and speech treatment all rank in the top eight, and the evaluations rank 6th to 8th. A practice that adds an occupational therapist or a speech-language pathologist to a PT clinic is not diluting its Medicaid economics.
This also matters for pediatric and developmental practices, which often treat the same child across two or three disciplines. When every discipline is priced well, a coordinated plan of care can be built around clinical need rather than around which codes pay best.
Hawaii therapy wages sit close to the national medians. In May 2025, physical therapists earned a median $48.90 an hour against $49.40 nationally, occupational therapists $49.46 against $48.24, and speech-language pathologists $46.90 against $47.05. Physical therapist assistants earned $32.46 against $32.88, and occupational therapy assistants $34.96 against $34.76.
With above-median rates and median wages, the margins are wide:
- Physical therapy (97110): wages take 56.6% of the $122.88 hourly rate, leaving $53.38 an hour after a loaded wage.
- Occupational therapy (97530): wages take 46.9% of the $149.84 hourly rate, leaving $79.54.
Those figures leave real room for documentation time, inter-island travel and cancellations. At these levels, Medicaid therapy volume can carry its share of a practice's overhead rather than depending on commercial payers to subsidize it.
A wide margin is only useful if it pays for something. In Hawaii, three costs are the natural uses.
Inter-island and home-based care
Serving patients on neighbor islands or in the home involves travel time that earns nothing. The Hawaii margin can absorb a meaningful amount of that unpaid time, which makes outreach models more viable here than in states where the margin is a few dollars an hour.
Recruitment and retention
Wages near the national median do not mean therapists are easy to hire. Practices can use part of the margin for signing incentives, continuing education or reduced productivity targets that improve retention.
Assistants as a capacity tool
Because assistant wages are also close to national figures, the case for assistant-delivered care in Hawaii is about capacity rather than survival: assistants let a practice treat more patients, not just break even.
Therapy is a small part of Hawaii Medicaid, but it sits inside a program with many moving pieces. Med-QUEST runs a core fee-for-service schedule, a separate dental schedule, home- and community-based service rates issued through QI memos, an intellectual and developmental disability waiver, and ABA and intensive behavioral therapy rates published under their own memo. QUEST Integration plans then layer their own contracts on top.
Where therapy overlaps with other programs
Children receiving ABA or developmental disability services often also receive speech or occupational therapy. Those services are billed under different programs with different rules, so a practice that serves the same family across programs should keep separate billing workflows for each. A speech session billed under the therapy schedule and an ABA session billed under the behavioral therapy memo can look similar on a calendar but are priced and authorized independently.
Why the physician rule does not carry over
Hawaii requires plans to pay at least the published rate for physician and practitioner services. Practices that bill both evaluation-and-management visits and therapy sometimes assume the same floor applies to therapy. It does not: for therapy, plans negotiate. Contract reviews should treat the two service lines separately.
Hawaii pairs its high rates with a heavier authorization load than many states:
- 92507, 97110, 97112 and 97530: three prior-authorization rules each.
- 92521, 92522, 92523 and 92524 (speech-language evaluations): two rules each.
- 97161 (PT evaluation): one rule.
No unit limits are listed. Because the core treatment codes for PT, OT and speech each carry three rules, authorization tracking is an operational priority. A missed or lapsed authorization forfeits a visit that would otherwise be among the better-paid Medicaid therapy visits in the country.
Hawaii delivers Medicaid through QUEST Integration managed-care plans and fee-for-service Med-QUEST. Our data counts 9 plans and administrators, including AlohaCare, Hawaii Medical Service Association (HMSA), Kaiser Foundation Health Plan, UnitedHealthcare Community Plan and 'Ohana Health Plan.
For physical, occupational and speech therapy, the rule on file is: plans negotiate; the published rate applies out of network. That is a different rule from Hawaii's physician and practitioner services, where plans must pay at least the published rate. For a therapy practice, the contract with each QUEST Integration plan sets the in-network rate, and the strong Med-QUEST fee schedule serves as the out-of-network reference. The Hawaii managed-care page lists the plans on file.
Negotiating with QUEST Integration plans
Because plans are not bound to the published rate for therapy, a plan offer below the Med-QUEST schedule is possible. The fee schedule is the practice's best anchor: a plan asking a provider to accept less than the state's own out-of-network rate is asking for a discount that the practice can weigh against the volume and administrative convenience the plan brings.
Hawaii's $79.39 rate for 92507 places it 6th of 39, behind Washington ($144.10), Alaska ($118.16), Arizona ($109.12), Texas ($107.78) and North Dakota ($85.24). The speech-language evaluation under 92522 pays $114.48, 25.4% above the $91.32 median.
The PT and OT evaluations are similarly strong at $104.43 and $107.40. Pediatric practices with high intake volume benefit from the evaluation rates as much as from the treatment rates. Because the evaluation codes also carry authorization rules, intake staff should secure approval for the evaluation itself and then for the treatment plan that follows.
On physical therapy, Hawaii's $122.88 sits behind Alaska ($176.68), New Mexico ($165.64), Montana ($147.04), Texas ($135.00) and North Dakota ($129.16), and far above the bottom of the table, where New Jersey pays $58.80, California $48.88 and Maine $46.64.
Among Pacific states, Hawaii's breadth stands out. Groups that also operate on the mainland can compare Washington therapy rates and Oregon therapy rates, which price the disciplines differently.
- Budgeting: model PT at $122.88 an hour and OT at $149.84, then apply wage and overhead costs; the margin examples above are a starting point.
- Plan contracting: use the Med-QUEST schedule as the benchmark when reviewing QUEST Integration offers.
- Authorization: track approvals by code; the three-rule treatment codes need the closest attention.
- Monitoring: watch for new editions of the fee-for-service schedule, since every therapy rate moves together when Hawaii issues one.
Rates on this page are compiled from official Hawaii Med-QUEST publications, chiefly the Medicaid Fee-For-Service (FFS) Fee Schedule, without modifiers, as of 2026-06-01. Each rate links to its source document. Hourly figures convert 15-minute units to an hour, and ranks compare the same service across states on that basis. Wages are May 2025 state and national medians.
This page covers therapy only; the Hawaii Medicaid rates hub covers all 17,383 current Hawaii Medicaid rates. The national therapy rates hub compares every state, our methodology explains conversions and ranks, and pricing describes full-dataset access.