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Medicare payment locality · Q1 2018 release

Detroit flag

Detroit

Michigan MAC 08202 · Locality 01

Work GPCI
1.000
Practice expense GPCI
0.989
Malpractice GPCI
1.691

The GPCIs fall on both sides of the national baseline of 1.000, so whether a code pays more or less here depends on its mix of work, practice-expense and malpractice RVUs.

Effective CMS RVU18A Updated

Price a code in Detroit Copy link

The locality-adjusted amount for the Q1 2018 release, with the facility and office settings and the full calculation.

ZIP codes in this locality Copy link

Detroit covers 249 ZIP codes across MI, per the CMS ZIP-to-locality crosswalk (Q1 2018). 8 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.

  • 48005 (split ZIP)
  • 48007
  • 48009
  • 48012
  • 48015
  • 48017
  • 48021
  • 48025
  • 48026
  • 48030
  • 48033
  • 48034
  • 48035
  • 48036
  • 48037
  • 48038
  • 48042
  • 48043
  • 48044
  • 48045
  • 48046
  • 48047
  • 48048
  • 48050
  • 48051
  • 48062 (split ZIP)
  • 48065
  • 48066
  • 48067
  • 48068
  • 48069
  • 48070
  • 48071
  • 48072
  • 48073
  • 48075
  • 48076
  • 48080
  • 48081
  • 48082
  • 48083
  • 48084
  • 48085
  • 48086
  • 48088
  • 48089
  • 48090
  • 48091
  • 48092
  • 48093
  • 48094
  • 48095
  • 48096
  • 48098
  • 48099
  • 48101
  • 48102
  • 48103
  • 48104
  • 48105
Show all 249 ZIP codes
  • 48106
  • 48107
  • 48108
  • 48109
  • 48111
  • 48112
  • 48113
  • 48115
  • 48118
  • 48120
  • 48121
  • 48122
  • 48123
  • 48124
  • 48125
  • 48126
  • 48127
  • 48128
  • 48130
  • 48134
  • 48135
  • 48136
  • 48138
  • 48141
  • 48146
  • 48150
  • 48151
  • 48152
  • 48153
  • 48154
  • 48158
  • 48164
  • 48165
  • 48167
  • 48168
  • 48170
  • 48173
  • 48174
  • 48175
  • 48176
  • 48178 (split ZIP)
  • 48180
  • 48183
  • 48184
  • 48185
  • 48186
  • 48187
  • 48188
  • 48189 (split ZIP)
  • 48190
  • 48191
  • 48192
  • 48193
  • 48195
  • 48197
  • 48198
  • 48201
  • 48202
  • 48203
  • 48204
  • 48205
  • 48206
  • 48207
  • 48208
  • 48209
  • 48210
  • 48211
  • 48212
  • 48213
  • 48214
  • 48215
  • 48216
  • 48217
  • 48218
  • 48219
  • 48220
  • 48221
  • 48222
  • 48223
  • 48224
  • 48225
  • 48226
  • 48227
  • 48228
  • 48229
  • 48230
  • 48231
  • 48232
  • 48233
  • 48234
  • 48235
  • 48236
  • 48237
  • 48238
  • 48239
  • 48240
  • 48242
  • 48243
  • 48244
  • 48254
  • 48255
  • 48258
  • 48260
  • 48264
  • 48265
  • 48266
  • 48267
  • 48268
  • 48269
  • 48272
  • 48274
  • 48275
  • 48277
  • 48278
  • 48279
  • 48288
  • 48295
  • 48297
  • 48299
  • 48301
  • 48302
  • 48303
  • 48304
  • 48306
  • 48307
  • 48308
  • 48309
  • 48310
  • 48311
  • 48312
  • 48313
  • 48314
  • 48315
  • 48316
  • 48317
  • 48318
  • 48320
  • 48321
  • 48322
  • 48323
  • 48324
  • 48325
  • 48326
  • 48327
  • 48328
  • 48329
  • 48330
  • 48331
  • 48332
  • 48333
  • 48334
  • 48335
  • 48336
  • 48340
  • 48341
  • 48342
  • 48343
  • 48346
  • 48347
  • 48348
  • 48350
  • 48356
  • 48357
  • 48359
  • 48360
  • 48361
  • 48362
  • 48363
  • 48366
  • 48367
  • 48370
  • 48371 (split ZIP)
  • 48374
  • 48375
  • 48376
  • 48377
  • 48380 (split ZIP)
  • 48381
  • 48382
  • 48383
  • 48386
  • 48387
  • 48390
  • 48391
  • 48393
  • 48397
  • 48398
  • 48442 (split ZIP)
  • 48462 (split ZIP)

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 0.965 1.686
January 2024 to October 2025 1.003 0.986 1.718
January 2023 to October 2023 1.000 0.992 1.670
January 2021 to October 2022 1.000 0.997 1.622
January 2020 to October 2020 1.000 0.993 1.657
January 2018 to October 2019 (this page) 1.000 0.989 1.691
January 2017 to October 2017 1.000 0.992 1.510
January 2015 to October 2016 1.000 0.994 1.328
April 2014 to October 2014 1.010 1.009 1.571
January 2013 to April 2013 1.022 1.023 1.814

Example rates in Detroit Copy link

National and local Office (non-facility) amounts for frequently reviewed codes in the Q1 2018 release, before sequestration. Conversion factor: 2018 standard (non-QP) physician conversion factor, $35.9996.

Code National Local Difference
99214 $109.44 $111.36 +1.8%
99213 $74.16 $75.50 +1.8%
99215 $147.60 $150.60 +2.0%
66984 $656.27 $667.59 +1.7%
99204 $167.40 $172.08 +2.8%
92014 $128.52 $129.18 +0.5%
97110 $31.32 $31.66 +1.1%
88305 $70.20 $70.48 +0.4%
97530 $41.40 $41.62 +0.5%
99203 $109.80 $112.94 +2.9%

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 Detroit 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. Detroit currently has mixed GPCI components, so the net payment effect varies by code for the Q1 2018 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 8 ZIP codes in Detroit 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 Q1 2018 release (effective January 2018). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q1 2018 release. Example amounts use the standard (non-QP) physician conversion factor ($35.9996) 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 (Q1 2018) · rvu18ar1.zip (GPCI2018.csv row 67)
ZIP code to carrier locality crosswalk (Q1 2018) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JAN18.txt)

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