Medicare payment locality · Q3 2021 release

Arizona AZ Medicare Locality 00

MAC 03102 · Locality 00

This locality's GPCIs are all at or below the national baseline, so services priced with the standard RVU formula usually come out below the national amount for the Q3 2021 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.000

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

0.951

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

Malpractice GPCI

0.857

Adjusts the malpractice component using liability-cost data

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

Example rates in Arizona Copy link

National and Arizona Office (non-facility) amounts for frequently reviewed codes in the Q3 2021 release (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	Arizona	Difference
99214	$131.20	$127.59	-2.8%
99213	$92.47	$89.83	-2.9%
99215	$183.19	$178.31	-2.7%
66984	$548.17	$532.14	-2.9%
99204	$169.93	$165.29	-2.7%
92014	$128.41	$124.38	-3.1%
97110	$30.36	$29.57	-2.6%
88305	$71.53	$69.24	-3.2%
97530	$39.43	$38.18	-3.2%
99203	$113.75	$110.42	-2.9%

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

ZIP codes in this locality Copy link

Arizona covers 569 ZIP codes across AZ, per the CMS ZIP-to-locality crosswalk (Q3 2021). 2 of them span more than one locality and need ZIP+4 for an exact match.

85001 85002 85003 85004 85005 85006 85007 85008 85009 85010 85011 85012 85013 85014 85015 85016 85017 85018 85019 85020 85021 85022 85023 85024 85025 85026 85027 85028 85029 85030 85031 85032 85033 85034 85035 85036 85037 85038 85039 85040 85041 85042 85043 85044 85045 85046 85048 85050 85051 85053 85054 85055 85060 85061 85062 85063 85064 85065 85066 85067 85068 85069 85070 85071 85072 85073 85074 85075 85076 85077 85078 85079 85080 85082 85083 85085 85086 85087 85096 85097 85098 85099 85117 85118 85119 85120 85121 85122 85123 85127 85128 85130 85131 85132 85135 85137 85138 85139 85140 85141 85142 85143 85145 85147 85172 85173 85178 85190 85191 85192 85193 85194 85201 85202 85203 85204 85205 85206 85207 85208 85209 85210 85211 85212 85213 85214 85215 85216 85217 85218 85219 85220 85221 85222 85223 85224 85225 85226 85227 85228 85230 85231 85232 85233 85234 85235 85236 85237 85238 85239 85240 85241 85242 85243 85244 85245 85246 85247 85248 85249 85250 85251 85252 85253 85254 85255 85256 85257 85258 85259 85260 85261 85262 85263 85264 85266 85267 85268 85269 85271 85272 85273 85274 85275 85277 85278 85279 85280 85281 85282 85283 85284 85285 85286 85287 85289 85290 85291 85292 85293 85294 85295 85296 85297 85298 85299 85301 85302 85303 85304 85305 85306 85307 85308 85309 85310 85311 85312 85313 85318 85320 85321 85322 85323 85324 85325 85326 85327 85328 85329 85331 85332 85333 85334 85335 85336 85337 85338 85339 85340 85341 85342 85343 85344 85345 85346 85347 85348 85349 85350 85351 85352 85353 85354 85355 85356 85357 85358 85359 85360 85361 85362 85363 85364 85365 85366 85367 85369 85371 85372 85373 85374 85375 85376 85377 85378 85379 85380 85381 85382 85383 85385 85387 85388 85390 85392 85395 85396 85501 85502 85530 85531 85532 85533 85534 85535 85536 85539 85540 85541 85542 85543 85544 85545 85546 85547 85548 85550 85551 85552 85553 85554 85601 85602 85603 85605 85606 85607 85608 85609 85610 85611 85613 85614 85615 85616 85617 85618 85619 85620 85621 85622 85623 85624 85625 85626 85627 85628 85629 85630 85631 85632 85633 85634 85635 85636 85637 85638 85639 85640 85641 85643 85644 85645 85646 85648 85650 85652 85653 85654 85655 85658 85662 85670 85671 85701 85702 85703 85704 85705 85706 85707 85708 85709 85710 85711 85712 85713 85714 85715 85716 85717 85718 85719 85720 85721 85722 85723 85724 85725 85726 85728 85730 85731 85732 85733 85734 85735 85736 85737 85738 85739 85740 85741 85742 85743 85744 85745 85746 85747 85748 85749 85750 85751 85752 85754 85755 85756 85757 85775 85777 85901 85902 85911 85912 85920 85922 85923 85924 85925 85926 85927 85928 85929 85930 85931 85932 85933 85934 85935 85936 85937 85938 85939 85940 85941 85942 86001 86002 86003 86004 86005 86011 86015 86016 86017 86018 86020 86021 86022 86023 86024 86025 86028 86029 86030 86031 86032 86033 86034 86035 86036 86038 86039 86040 86042 86043 86044 86045 86046 86047 86052 86053 86054 86301 86302 86303 86304 86305 86312 86313 86314 86315 86320 86321 86322 86323 86324 86325 86326 86327 86329 86330 86331 86332 86333 86334 86335 86336 86337 86338 86339 86340 86341 86342 86343 86351 86401 86402 86403 86404 86405 86406 86409 86411 86412 86413 86426 86427 86429 86430 86431 86432 86433 86434 86435 86436 86437 86438 86439 86440 86441 86442 86443 86444 86445 86446 86502 86503 86504 86505 86506 86507 86508 86510 86511 86512 86514 86515 86520 86535 86538 86540 86544 86545 86547 86549 86555 86556

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

Common questions Copy link

Why do Medicare rates in Arizona 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 costs for physician work, running an office, and liability insurance therefore move the final amount up or down. Arizona currently has all three GPCIs at or below the national baseline, so services priced with the standard RVU formula usually come out below the national amount for the Q3 2021 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 ZIP code where the service was performed to assign a claim to its contractor and locality. Look up your ZIP to find your locality. About 2 ZIP codes in Arizona span more than one locality and need the 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 pay a percentage of Medicare, but its own wording decides which Medicare release, percentage, geography, and adjustments apply.

Does my locality affect what I owe as a patient?

For a covered service, a higher allowed amount in your locality usually means a higher 20% coinsurance. 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. GPCIs are usually set once a year in the fee schedule rule, though later files can correct them. See what changed each release.

Source & method Copy link

We compute GPCIs and rates from the CMS Medicare Physician Fee Schedule Q3 2021 release (effective July 2021). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2021 release. Example amounts use the standard (non-QP) physician conversion factor ($34.8931) and apply this locality's GPCIs to nationally priced Office (non-facility) RVUs, before the ~2% sequestration cut. Past releases are never edited, so a rate for an earlier quarter always matches what CMS published for it.

Geographic practice cost indices (Q3 2021) · rvu21c-updated-6302021.zip (GPCI2021.csv row 6)

ZIP code to carrier locality crosswalk (Q3 2021) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JUL2021.txt)

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