Medicare payment locality · Q2 2021 release

Baltimore/Surr. Counties, Md MD Medicare Locality 01

MAC 12302 · Locality 01

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 Q2 2021 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.028

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.096

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

Malpractice GPCI

1.313

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 Baltimore/Surr. Counties, Md Copy link

National vs. Baltimore/Surr. Counties, Md office (non-facility) amounts for frequently reviewed codes, Q2 2021 (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	Baltimore/Surr. Counties, Md	Difference
99214	$131.20	$140.30	+6.9%
99213	$92.47	$99.02	+7.1%
99215	$183.19	$195.72	+6.8%
66984	$548.17	$587.37	+7.2%
99204	$169.93	$181.82	+7.0%
92014	$128.41	$137.74	+7.3%
97110	$30.36	$32.35	+6.6%
88305	$71.53	$76.77	+7.3%
97530	$39.43	$42.32	+7.3%
99203	$113.75	$122.01	+7.3%

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

Baltimore/Surr. Counties, Md covers 202 ZIP codes across MD, per the CMS ZIP-to-locality crosswalk (Q2 2021). 5 of them span more than one locality and need ZIP+4 for an exact match.

20588 20701 20711 20723 20724 20733 20751 20755 20758 20759 20763 20764 20765 20776 20777 20778 20779 20794 21001 21005 21009 21010 21012 21013 21014 21015 21017 21018 21020 21022 21023 21027 21028 21029 21030 21031 21032 21034 21035 21036 21037 21040 21041 21042 21043 21044 21045 21046 21047 21048 21050 21051 21052 21053 21054 21055 21056 21057 21060 21061 21062 21065 21071 21074 21075 21076 21077 21078 21080 21082 21084 21085 21087 21088 21090 21092 21093 21094 21098 21102 21104 21105 21106 21108 21111 21113 21114 21117 21120 21122 21123 21128 21130 21131 21132 21133 21136 21139 21140 21144 21146 21150 21152 21153 21154 21155 21156 21157 21158 21160 21161 21162 21163 21200 21201 21202 21203 21204 21205 21206 21207 21208 21209 21210 21211 21212 21213 21214 21215 21216 21217 21218 21219 21220 21221 21222 21223 21224 21225 21226 21227 21228 21229 21230 21231 21233 21234 21235 21236 21237 21239 21240 21241 21244 21250 21251 21252 21260 21261 21263 21264 21265 21268 21270 21273 21274 21275 21278 21279 21280 21281 21282 21283 21284 21285 21286 21287 21288 21289 21290 21297 21298 21401 21402 21403 21404 21405 21409 21411 21412 21723 21737 21738 21757 21764 21765 21776 21784 21787 21791 21794 21797

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

Common questions Copy link

Why do Medicare rates in Baltimore/Surr. Counties, Md 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. Baltimore/Surr. Counties, Md 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 Q2 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 5 ZIP codes in Baltimore/Surr. Counties, Md 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 2021 release (effective April 2021). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q2 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 (Q2 2021) · rvu21b-updated-03022021.zip (GPCI2021.csv row 63)

ZIP code to carrier locality crosswalk (Q2 2021) · Zip-Code-to-Carrier-Locality.zip (ZIP5_APR2021.txt)

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