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Medicare payment locality · Q4 2024 release

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Idaho

Idaho MAC 02202 · Locality 00

Work GPCI
1.000
Practice expense GPCI
0.908
Malpractice GPCI
0.461

All three GPCIs are at or below the national baseline of 1.000, so codes priced with the standard RVU formula usually pay less here than the national amount.

Effective CMS RVU24D Updated

Price a code in Idaho Copy link

The locality-adjusted amount for the Q4 2024 release, with the facility and office settings and the full calculation.

ZIP codes in this locality Copy link

Idaho covers 335 ZIP codes across ID, per the CMS ZIP-to-locality crosswalk (Q3 2024). 3 of them, outlined with a dashed border below, span more than one locality: CMS places those by ZIP+4, so this locality holds for only part of each.

We don't have the Q4 2024 ZIP-to-locality crosswalk file yet; figures are from the Q3 2024 release and may not reflect Q4 2024 changes.

  • 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
Show all 335 ZIP codes
  • 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 (split ZIP)
  • 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 (split ZIP)
  • 83855
  • 83856 (split ZIP)
  • 83857
  • 83858
  • 83860
  • 83861
  • 83862
  • 83864
  • 83865
  • 83866
  • 83867
  • 83868
  • 83869
  • 83870
  • 83871
  • 83872
  • 83873
  • 83874
  • 83876
  • 83877
  • 83888

Have a service address? Look up its ZIP and date of service to confirm the locality.

GPCI history Copy link

This locality's GPCIs in each release on file, newest first. Releases with unchanged GPCIs share a row.

Release Work PE MP
January 2026 to October 2026 1.000 0.920 0.473
January 2024 to October 2025 (this page) 1.000 0.908 0.461
January 2023 to October 2023 1.000 0.893 0.439
January 2021 to October 2022 1.000 0.877 0.416
January 2020 to October 2020 1.000 0.890 0.464
January 2018 to October 2019 1.000 0.902 0.512
January 2017 to October 2017 1.000 0.900 0.510
January 2015 to October 2016 1.000 0.898 0.508
April 2014 to October 2014 1.000 0.896 0.556
January 2013 to April 2013 1.000 0.894 0.603

Example rates in Idaho Copy link

National and local Office (non-facility) amounts for frequently reviewed codes in the Q4 2024 release, before sequestration. Conversion factor: 2024 standard (non-QP) physician conversion factor, $33.2875.

Code National Local Difference
99214 $128.16 $120.16 -6.2%
99213 $90.87 $85.01 -6.4%
99215 $180.42 $169.12 -6.3%
66984 $537.26 $502.16 -6.5%
99204 $167.10 $156.12 -6.6%
92014 $125.49 $117.70 -6.2%
97110 $29.29 $27.83 -5.0%
88305 $71.57 $66.98 -6.4%
97530 $36.62 $34.45 -5.9%
99203 $111.51 $103.77 -6.9%

Need the facility amount, a modifier, or a date of service? Use the rate calculator, already set to this locality. Or start with your field's usual procedure mix on the specialty fee schedules.

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 costs for physician work, running an office, and liability insurance therefore move the final amount up or down. Idaho currently has all three GPCIs at or below the national baseline, so services priced with the standard RVU formula usually come out below the national amount for the Q4 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 ZIP code where the service was performed to assign a claim to its contractor and locality. Look up your ZIP to find your locality. About 3 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 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 2024 release (effective October 2024). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2024 release. Example amounts use the standard (non-QP) physician conversion factor ($33.2875) 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 2024) · rvu24d.zip (GPCI2024.csv row 47)
ZIP code to carrier locality crosswalk (Q3 2024) · zip-code-to-carrier-locality.zip (ZIP5_JUL2024.txt)

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