Medicare payment locality · Q2 2018 release

Salinas, Ca CA Medicare Locality 64

MAC 01112 · Locality 64

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q2 2018 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.024

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.092

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

Malpractice GPCI

0.562

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 Salinas, Ca Copy link

National vs. Salinas, Ca office (non-facility) amounts for frequently reviewed codes, Q2 2018 (before sequestration). Conversion factor: 2018 standard (non-QP) physician conversion factor · $35.9996.

Code	National	Salinas, Ca	Difference
99214	$109.44	$113.93	+4.1%
99213	$74.16	$77.27	+4.2%
99215	$147.60	$153.15	+3.8%
66984	$656.27	$684.35	+4.3%
99204	$167.40	$172.65	+3.1%
92014	$128.52	$135.72	+5.6%
97110	$31.32	$32.72	+4.5%
88305	$70.20	$74.25	+5.8%
97530	$41.40	$43.75	+5.7%
99203	$109.80	$113.56	+3.4%

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

Salinas, Ca covers 35 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q2 2018). 3 of them span more than one locality and need ZIP+4 for an exact match.

93426 93450 93901 93902 93905 93906 93907 93908 93912 93915 93920 93921 93922 93923 93924 93925 93926 93927 93928 93930 93932 93933 93940 93942 93943 93944 93950 93953 93954 93955 93960 93962 95004 95012 95039

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

Common questions Copy link

Why do Medicare rates in Salinas, 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. Salinas, Ca currently has mixed GPCI components, so the net payment effect varies by code for the Q2 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 service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. About 3 ZIP codes in Salinas, 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 Q2 2018 release (effective April 2018). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q2 2018 release . Example amounts use the standard (non-QP) physician conversion factor ($35.9996) 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 (Q2 2018) · rvu18b.zip (GPCI2018.csv row 23)

ZIP code to carrier locality crosswalk (Q2 2018) · Zip-Code-to-Carrier-Locality.zip (ZIP5_APR18.txt)

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