Medicare payment locality · Q2 2024 release

Delaware DE Medicare Locality 01

MAC 12102 · Locality 01

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q2 2024 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.009

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

0.992

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

Malpractice GPCI

0.949

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 Delaware Copy link

National vs. Delaware office (non-facility) amounts for frequently reviewed codes, Q2 2024 (before sequestration). Conversion factor: 2024 standard (non-QP) physician conversion factor · $33.2875.

Code	National	Delaware	Difference
99214	$128.16	$128.02	-0.1%
99213	$90.87	$90.74	-0.1%
99215	$180.42	$180.24	-0.1%
66984	$537.26	$536.33	-0.2%
99204	$167.10	$166.89	-0.1%
92014	$125.49	$125.24	-0.2%
97110	$29.29	$29.30	0.0%
88305	$71.57	$71.39	-0.3%
97530	$36.62	$36.56	-0.2%
99203	$111.51	$111.30	-0.2%

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

Delaware covers 99 ZIP codes across DE, per the CMS ZIP-to-locality crosswalk (Q2 2024). 1 of them span more than one locality and need ZIP+4 for an exact match.

The Q2 2024 ZIP-to-locality crosswalk file is not a captured CMS release; each reconstructed field has high confidence from bracketing CMS files and documented effective-quarter changes, but the original CMS artifact has not been recovered.

19701 19702 19703 19706 19707 19708 19709 19710 19711 19712 19713 19714 19715 19716 19717 19718 19720 19721 19725 19726 19730 19731 19732 19733 19734 19735 19736 19801 19802 19803 19804 19805 19806 19807 19808 19809 19810 19850 19880 19884 19885 19886 19887 19889 19890 19891 19892 19893 19894 19895 19896 19897 19898 19899 19901 19902 19903 19904 19905 19906 19930 19931 19933 19934 19936 19938 19939 19940 19941 19942 19943 19944 19945 19946 19947 19950 19951 19952 19953 19954 19955 19956 19958 19960 19961 19962 19963 19964 19966 19967 19968 19969 19970 19971 19973 19975 19977 19979 19980

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

Common questions Copy link

Why do Medicare rates in Delaware 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. Delaware currently has mixed GPCI components, so the net payment effect varies by code for the Q2 2024 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 1 ZIP codes in Delaware 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 2024 release (effective April 2024). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q2 2024 release . Example amounts use the standard (non-QP) physician conversion factor ($33.2875) 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 2024) · rvu24b-updated-03-18-2024.zip (GPCI2024.csv row 40)

ZIP code to carrier locality crosswalk (Q2 2024) · ZIP5_APR2024_RECONSTRUCTED.zip (ZIP5_APR2024_RECONSTRUCTED.txt)

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