Southern Maine (ME) Medicare rates & GPCIs—Q3 2021

Work GPCI

1.000

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

0.997

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

Malpractice GPCI

0.652

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 Southern Maine Copy link

National and Southern Maine Office (non-facility) amounts for frequently reviewed codes in the Q3 2021 release (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	Southern Maine	Difference
99214	$131.20	$129.32	-1.4%
99213	$92.47	$91.12	-1.5%
99215	$183.19	$180.40	-1.5%
66984	$548.17	$540.92	-1.3%
99204	$169.93	$166.92	-1.8%
92014	$128.41	$127.57	-0.7%
97110	$30.36	$30.07	-1.0%
88305	$71.53	$71.15	-0.5%
97530	$39.43	$39.12	-0.8%
99203	$113.75	$111.77	-1.7%

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

ZIP codes in this locality Copy link

Southern Maine covers 96 ZIP codes across ME, per the CMS ZIP-to-locality crosswalk (Q3 2021). 1 of them span more than one locality and need ZIP+4 for an exact match.

03901 03902 03903 03904 03905 03906 03907 03908 03909 03910 03911 04001 04002 04003 04004 04005 04006 04007 04009 04011 04013 04014 04015 04017 04019 04020 04021 04024 04027 04028 04029 04030 04032 04033 04034 04038 04039 04040 04042 04043 04046 04047 04048 04049 04050 04053 04054 04055 04056 04057 04061 04062 04063 04064 04066 04069 04070 04071 04072 04073 04074 04075 04076 04077 04078 04079 04082 04083 04084 04085 04087 04090 04091 04092 04093 04094 04095 04096 04097 04098 04101 04102 04103 04104 04105 04106 04107 04108 04109 04110 04112 04116 04122 04123 04124 04260

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

Common questions Copy link

Why do Medicare rates in Southern Maine 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. Southern Maine 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 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 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 1 ZIP codes in Southern Maine 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 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 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 (Q3 2021) · rvu21c-updated-6302021.zip (GPCI2021.csv row 61)

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

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