Medicare payment locality · Q4 2023 release

Fresno, Ca CA Medicare Locality 56

MAC 01112 · Locality 56

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q4 2023 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.021

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.079

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

Malpractice GPCI

0.579

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 Fresno, Ca Copy link

National and Fresno, Ca Office (non-facility) amounts for frequently reviewed codes in the Q4 2023 release (before sequestration). Conversion factor: 2023 standard (non-QP) physician conversion factor · $33.8872.

Code	National	Fresno, Ca	Difference
99214	$128.43	$132.43	+3.1%
99213	$90.82	$93.74	+3.2%
99215	$179.94	$185.26	+3.0%
66984	$541.86	$560.90	+3.5%
99204	$167.40	$171.62	+2.5%
92014	$127.08	$133.65	+5.2%
97110	$29.82	$31.12	+4.4%
88305	$71.84	$75.70	+5.4%
97530	$37.61	$39.55	+5.2%
99203	$112.84	$115.73	+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

Fresno, Ca covers 105 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q4 2023). 11 of them span more than one locality and need ZIP+4 for an exact match.

93210 93234 93242 93602 93605 93606 93607 93608 93609 93611 93612 93613 93616 93619 93621 93622 93624 93625 93626 93627 93628 93629 93630 93631 93634 93640 93641 93642 93646 93648 93649 93650 93651 93652 93654 93656 93657 93660 93662 93664 93667 93668 93675 93701 93702 93703 93704 93705 93706 93707 93708 93709 93710 93711 93712 93714 93715 93716 93717 93718 93720 93721 93722 93723 93724 93725 93726 93727 93728 93729 93730 93737 93740 93741 93744 93745 93747 93750 93755 93759 93760 93761 93762 93764 93765 93771 93772 93773 93774 93775 93776 93777 93778 93779 93780 93782 93784 93786 93790 93791 93792 93793 93794 93844 93888

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

Common questions Copy link

Why do Medicare rates in Fresno, 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. Fresno, Ca currently has mixed GPCI components, so the net payment effect varies by code for the Q4 2023 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 11 ZIP codes in Fresno, 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 Q4 2023 release (effective October 2023). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 2023 release. Example amounts use the standard (non-QP) physician conversion factor ($33.8872) 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 (Q4 2023) · rvu23d.zip (GPCI2023.csv row 11)

ZIP code to carrier locality crosswalk (Q4 2023) · 2023-end-year-zip-code-file.zip (ZIP5_DEC2023_FINAL.txt)

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