Background: Most cases of hepatocellular carcinoma (HCC) occur in high-risk patients. Guidelines from expert societies recommend HCC surveillance with ultrasound with or without serum alpha fetoprotein every 6 months for these patients, but fewer than 20% undergo recommended surveillance. The objective of this study was to identify patient-level barriers to surveillance from the provider perspective. Methods: Qualitative research methods were employed. Purposive sampling was used to invite primary care providers from the Departments of Internal Medicine and Family and Community Medicine and specialty providers from the Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, to participate. A semi-structured guide was used to conduct one-on-one interviews. Transcribed interviews were analyzed to reveal emergent themes. Results: 22 providers were interviewed including physicians and nurse practitioners in primary care, gastroenterology and hepatology. Providers reported various patient-level barriers to HCC surveillance including transportation, travel distance, insurance issues, scheduling difficulties, distrust of the medical community, language barriers, busy life obligations, difficulty obtaining time off work, inadequate support systems, difficulty coordinating with local centers, religious fatalism, continued substance abuse, and poor health literacy (Table). Conclusions: Providers identified many important patient-level barriers to HCC surveillance in high-risk patients. Future research should focus on the design, testing and implementation of interventions to target and address these patient-level barriers and improve HCC surveillance in this population.