Medicare payment locality · Q2 2022 release

Southern Maine ME Medicare Locality 03

MAC 14112 · Locality 03

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 Q2 2022 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

0.997

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. Above raises that component; below lowers it. GPCIs are Medicare payment factors, not general cost-of-living or physician-compensation indexes.

Example rates in Southern Maine Copy link

National vs. Southern Maine office (non-facility) amounts for frequently reviewed codes, Q2 2022 (before sequestration). Conversion factor: 2022 standard (non-QP) physician conversion factor · $34.6062.

Code	National	Southern Maine	Difference
99214	$129.77	$128.15	-1.2%
99213	$92.05	$90.72	-1.4%
99215	$183.07	$180.30	-1.5%
66984	$544.70	$537.14	-1.4%
99204	$169.57	$166.47	-1.8%
92014	$128.39	$127.55	-0.7%
97110	$30.11	$29.83	-0.9%
88305	$71.98	$71.60	-0.5%
97530	$38.07	$37.76	-0.8%
99203	$113.85	$111.65	-1.9%

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

Southern Maine covers 96 ZIP codes across ME, per the CMS ZIP-to-locality crosswalk (Q2 2022). 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 professional labor, office-input, and liability costs therefore move the final amount up or down. Southern Maine 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 Q2 2022 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 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 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 2022 release (effective April 2022). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q2 2022 release . Example amounts use the standard (non-QP) physician conversion factor ($34.6062) 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 2022) · rvu22b.zip (GPCI2022.csv row 61)

ZIP code to carrier locality crosswalk (Q2 2022) · Zip-Code-to-Carrier-Locality.zip (ZIP5_APR2022_V2.txt)

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