Medicare payment locality · Q1 2018 release

Bakersfield, Ca CA Medicare Locality 54

MAC 01112 · Locality 54

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q1 2018 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.020

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.074

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

Malpractice GPCI

0.599

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 Bakersfield, Ca Copy link

National and Bakersfield, Ca Office (non-facility) amounts for frequently reviewed codes in the Q1 2018 release (before sequestration). Conversion factor: 2018 standard (non-QP) physician conversion factor · $35.9996.

Code	National	Bakersfield, Ca	Difference
99214	$109.44	$112.91	+3.2%
99213	$74.16	$76.56	+3.2%
99215	$147.60	$151.85	+2.9%
66984	$656.27	$678.01	+3.3%
99204	$167.40	$171.30	+2.3%
92014	$128.52	$134.24	+4.5%
97110	$31.32	$32.42	+3.5%
88305	$70.20	$73.42	+4.6%
97530	$41.40	$43.27	+4.5%
99203	$109.80	$112.60	+2.6%

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

Bakersfield, Ca covers 70 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q1 2018). 8 of them span more than one locality and need ZIP+4 for an exact match.

93203 93205 93206 93215 93216 93220 93222 93224 93225 93226 93238 93240 93241 93243 93249 93250 93251 93252 93255 93263 93268 93276 93280 93283 93285 93287 93301 93302 93303 93304 93305 93306 93307 93308 93309 93311 93312 93313 93314 93380 93381 93382 93383 93384 93385 93386 93387 93388 93389 93390 93501 93502 93504 93505 93516 93518 93519 93523 93524 93527 93528 93531 93554 93555 93556 93558 93560 93561 93581 93596

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

Common questions Copy link

Why do Medicare rates in Bakersfield, Ca 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. Bakersfield, Ca currently has mixed GPCI components, so the net payment effect varies by code for the Q1 2018 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 8 ZIP codes in Bakersfield, Ca 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 Q1 2018 release (effective January 2018). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q1 2018 release. Example amounts use the standard (non-QP) physician conversion factor ($35.9996) 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 (Q1 2018) · rvu18ar1.zip (GPCI2018.csv row 8)

ZIP code to carrier locality crosswalk (Q1 2018) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JAN18.txt)

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