Medicare payment locality · Q3 2021 release

Idaho ID Medicare Locality 00

MAC 02202 · Locality 00

This locality's GPCIs are all at or below the national baseline, so normally RVU-priced services tend to price below 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

0.877

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

Malpractice GPCI

0.416

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 Idaho Copy link

National vs. Idaho 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	Idaho	Difference
99214	$131.20	$121.05	-7.7%
99213	$92.47	$85.06	-8.0%
99215	$183.19	$169.30	-7.6%
66984	$548.17	$503.77	-8.1%
99204	$169.93	$156.49	-7.9%
92014	$128.41	$117.90	-8.2%
97110	$30.36	$28.23	-7.0%
88305	$71.53	$65.63	-8.2%
97530	$39.43	$36.15	-8.3%
99203	$113.75	$104.21	-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

Idaho covers 335 ZIP codes across ID, 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.

83201 83202 83203 83204 83205 83206 83209 83210 83211 83212 83213 83214 83215 83217 83218 83220 83221 83223 83226 83227 83228 83229 83230 83232 83233 83234 83235 83236 83237 83238 83239 83241 83243 83244 83245 83246 83250 83251 83252 83253 83254 83255 83256 83261 83262 83263 83271 83272 83274 83276 83277 83278 83280 83281 83283 83285 83286 83287 83301 83302 83303 83311 83312 83313 83314 83316 83318 83320 83321 83322 83323 83324 83325 83327 83328 83330 83332 83333 83334 83335 83336 83337 83338 83340 83341 83342 83343 83344 83346 83347 83348 83349 83350 83352 83353 83354 83355 83401 83402 83403 83404 83405 83406 83415 83420 83421 83422 83423 83424 83425 83427 83428 83429 83431 83433 83434 83435 83436 83438 83440 83441 83442 83443 83444 83445 83446 83447 83448 83449 83450 83451 83452 83454 83455 83460 83462 83463 83464 83465 83466 83467 83468 83469 83501 83520 83522 83523 83524 83525 83526 83530 83531 83533 83535 83536 83537 83538 83539 83540 83541 83542 83543 83544 83545 83546 83547 83548 83549 83551 83552 83553 83554 83555 83601 83602 83604 83605 83606 83607 83610 83611 83612 83615 83616 83617 83619 83620 83622 83623 83624 83626 83627 83628 83629 83630 83631 83632 83633 83634 83635 83636 83637 83638 83639 83641 83642 83643 83644 83645 83646 83647 83648 83650 83651 83652 83653 83654 83655 83656 83657 83660 83661 83666 83669 83670 83671 83672 83676 83677 83680 83686 83687 83701 83702 83703 83704 83705 83706 83707 83708 83709 83711 83712 83713 83714 83715 83716 83717 83719 83720 83721 83722 83723 83724 83725 83726 83727 83728 83729 83730 83731 83732 83733 83735 83744 83756 83757 83788 83799 83801 83802 83803 83804 83805 83806 83808 83809 83810 83811 83812 83813 83814 83815 83816 83821 83822 83823 83824 83825 83826 83827 83830 83832 83833 83834 83835 83836 83837 83839 83840 83841 83842 83843 83844 83845 83846 83847 83848 83849 83850 83851 83852 83853 83854 83855 83856 83857 83858 83860 83861 83862 83864 83865 83866 83867 83868 83869 83870 83871 83872 83873 83874 83876 83877 83888

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

Common questions Copy link

Why do Medicare rates in Idaho 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. Idaho currently has all three GPCI components at or below the national baseline, so normally RVU-priced services tend to price below 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. About 2 ZIP codes in Idaho 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 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 50)

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

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