Medicare payment locality · Q4 2020 release

Miami, Fl FL Medicare Locality 04

MAC 09102 · Locality 04

This locality's GPCIs are all at or above the national baseline, so services priced with the standard RVU formula usually come out above the national amount 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

1.000

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.026

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

Malpractice GPCI

2.598

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 Miami, Fl Copy link

National and Miami, Fl Office (non-facility) amounts for frequently reviewed codes in the Q4 2020 release (before sequestration). Conversion factor: 2020 standard (non-QP) physician conversion factor · $36.0896.

Code	National	Miami, Fl	Difference
99214	$110.43	$118.14	+7.0%
99213	$76.15	$81.76	+7.4%
99215	$148.33	$158.71	+7.0%
66984	$557.58	$595.25	+6.8%
99204	$167.09	$181.64	+8.7%
92014	$128.12	$132.95	+3.8%
97110	$31.40	$32.93	+4.9%
88305	$71.46	$73.75	+3.2%
97530	$40.42	$42.19	+4.4%
99203	$109.35	$118.24	+8.1%

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

Miami, Fl covers 145 ZIP codes across FL, per the CMS ZIP-to-locality crosswalk (Q3 2020).

We don't have the Q4 2020 ZIP-to-locality crosswalk file yet; figures are from the Q3 2020 release and may not reflect Q4 2020 changes.

33001 33002 33010 33011 33012 33013 33014 33015 33016 33017 33018 33030 33031 33032 33033 33034 33035 33036 33037 33039 33040 33041 33042 33043 33044 33045 33050 33051 33052 33054 33055 33056 33070 33090 33092 33101 33102 33106 33107 33109 33110 33111 33112 33114 33116 33119 33121 33122 33124 33125 33126 33127 33128 33129 33130 33131 33132 33133 33134 33135 33136 33137 33138 33139 33140 33141 33142 33143 33144 33145 33146 33147 33148 33149 33150 33151 33152 33153 33154 33155 33156 33157 33158 33159 33160 33161 33162 33163 33164 33165 33166 33167 33168 33169 33170 33172 33173 33174 33175 33176 33177 33178 33179 33180 33181 33182 33183 33184 33185 33186 33187 33188 33189 33190 33191 33192 33193 33194 33195 33196 33197 33198 33199 33206 33222 33231 33233 33234 33238 33239 33242 33243 33245 33247 33255 33256 33257 33261 33265 33266 33269 33280 33283 33296 33299

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

Common questions Copy link

Why do Medicare rates in Miami, Fl 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. Miami, Fl currently has all three GPCIs at or above the national baseline, so services priced with the standard RVU formula usually come out above the national amount 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 ZIP code where the service was performed to assign a claim to its contractor 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 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 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 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 2020) · rvu20d-updated-11232020.zip (GPCI2020.csv row 44)

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

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