Medicare payment locality · Q4 2021 release

Oxnard-Thousand Oaks-Ventura, Ca CA Medicare Locality 17

MAC 01182 · Locality 17

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q4 2021 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.027

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.179

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

Malpractice GPCI

0.726

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 Oxnard-Thousand Oaks-Ventura, Ca Copy link

National vs. Oxnard-Thousand Oaks-Ventura, Ca office (non-facility) amounts for frequently reviewed codes, Q4 2021 (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	Oxnard-Thousand Oaks-Ventura, Ca	Difference
99214	$131.20	$142.29	+8.5%
99213	$92.47	$100.54	+8.7%
99215	$183.19	$197.81	+8.0%
66984	$548.17	$598.93	+9.3%
99204	$169.93	$182.92	+7.6%
92014	$128.41	$143.07	+11.4%
97110	$30.36	$33.09	+9.0%
88305	$71.53	$80.04	+11.9%
97530	$39.43	$43.84	+11.2%
99203	$113.75	$123.26	+8.4%

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

Oxnard-Thousand Oaks-Ventura, Ca covers 48 ZIP codes across CA, 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.

The Q4 2021 ZIP-to-locality crosswalk file is not on file here; figures are from the Q3 2021 release and may not reflect Q4 2021 revisions.

91319 91320 91358 91359 91360 91361 91362 91377 93001 93002 93003 93004 93005 93006 93007 93009 93010 93011 93012 93015 93016 93020 93021 93022 93023 93024 93030 93031 93032 93033 93034 93035 93036 93040 93041 93042 93043 93044 93060 93061 93062 93063 93064 93065 93066 93093 93094 93099

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

Common questions Copy link

Why do Medicare rates in Oxnard-Thousand Oaks-Ventura, 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. Oxnard-Thousand Oaks-Ventura, Ca currently has mixed GPCI components, so the net payment effect varies by code for the Q4 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 service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. About 2 ZIP codes in Oxnard-Thousand Oaks-Ventura, 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 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 2021 release (effective October 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 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 2021) · rvu21d.zip (GPCI2021.csv row 20)

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

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