Medicare payment locality · Q4 2020 release

El Centro, Ca CA Medicare Locality 71

MAC 01182 · Locality 71

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q4 2020 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.024

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.070

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

Malpractice GPCI

0.606

Adjusts the malpractice component using liability-cost data

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

Example rates in El Centro, Ca Copy link

National vs. El Centro, Ca office (non-facility) amounts for frequently reviewed codes, Q4 2020 (before sequestration). Conversion factor: 2020 standard (non-QP) physician conversion factor · $36.0896.

Code	National	El Centro, Ca	Difference
99214	$110.43	$113.83	+3.1%
99213	$76.15	$78.53	+3.1%
99215	$148.33	$152.70	+2.9%
66984	$557.58	$575.54	+3.2%
99204	$167.09	$171.07	+2.4%
92014	$128.12	$133.89	+4.5%
97110	$31.40	$32.51	+3.5%
88305	$71.46	$74.88	+4.8%
97530	$40.42	$42.18	+4.4%
99203	$109.35	$112.47	+2.9%

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

ZIP codes in this locality Copy link

El Centro, Ca covers 17 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q3 2020).

The Q4 2020 ZIP-to-locality crosswalk file is not on file here; figures are from the Q3 2020 release and may not reflect Q4 2020 revisions.

92222 92227 92231 92232 92233 92243 92244 92249 92250 92251 92257 92259 92266 92273 92275 92281 92283

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

Common questions Copy link

Why do Medicare rates in El Centro, 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 professional labor, office-input, and liability costs therefore move the final amount up or down. El Centro, Ca currently has mixed GPCI components, so the net payment effect varies by code for the Q4 2020 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 service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. A few ZIPs nationally span multiple localities and need 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 benchmark payment to Medicare, but its language controls the Medicare release, percentage, geographic basis, and other adjustments.

Does my locality affect what I owe as a patient?

For a particular covered service, a higher locality-adjusted allowed amount generally produces a higher percentage-based coinsurance amount. 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. GPCI policy values are generally established through annual rulemaking, although later files can contain corrections. See what changed each release.

Source & method Copy link

GPCIs and rates computed from the CMS Medicare Physician Fee Schedule Q4 2020 release (effective October 2020). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2020 release . Example amounts use the standard (non-QP) physician conversion factor ($36.0896) and apply this locality's GPCIs to nationally priced non-facility RVUs, before the ~2% sequestration cut. Releases are immutable: a rate retrieved for a past quarter always reflects that PFS release.

Geographic practice cost indices (Q4 2020) · rvu20d-updated-11232020.zip (GPCI2020.csv row 9)

ZIP code to carrier locality crosswalk (Q3 2020) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JUL2020.txt)

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