Medicare payment locality · Q3 2021 release

Miami, Fl FL Medicare Locality 04

MAC 09102 · Locality 04

This locality's GPCIs are all at or above the national baseline, so normally RVU-priced services tend to price above the national amount for the Q3 2021 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.000

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.023

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

Malpractice GPCI

2.629

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 Miami, Fl Copy link

National vs. Miami, Fl office (non-facility) amounts for frequently reviewed codes, Q3 2021 (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	Miami, Fl	Difference
99214	$131.20	$140.52	+7.1%
99213	$92.47	$99.15	+7.2%
99215	$183.19	$196.92	+7.5%
66984	$548.17	$584.58	+6.6%
99204	$169.93	$184.64	+8.7%
92014	$128.41	$133.02	+3.6%
97110	$30.36	$31.81	+4.8%
88305	$71.53	$73.69	+3.0%
97530	$39.43	$41.10	+4.2%
99203	$113.75	$123.49	+8.6%

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

Miami, Fl covers 145 ZIP codes across FL, per the CMS ZIP-to-locality crosswalk (Q3 2021).

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 professional labor, office-input, and liability costs therefore move the final amount up or down. Miami, Fl currently has all three GPCI components at or above the national baseline, so normally RVU-priced services tend to price above the national amount for the Q3 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. 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 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 Q3 2021 release (effective July 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 (Q3 2021) · rvu21c-updated-6302021.zip (GPCI2021.csv row 45)

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

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