Medicare payment locality · Q3 2021 release

Detroit MI Medicare Locality 01

MAC 08202 · Locality 01

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q3 2021 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.000

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

1.622

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 Detroit Copy link

National and Detroit 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	Detroit	Difference
99214	$131.20	$134.06	+2.2%
99213	$92.47	$94.51	+2.2%
99215	$183.19	$187.51	+2.4%
66984	$548.17	$558.85	+1.9%
99204	$169.93	$174.71	+2.8%
92014	$128.41	$129.26	+0.7%
97110	$30.36	$30.75	+1.3%
88305	$71.53	$71.83	+0.4%
97530	$39.43	$39.79	+0.9%
99203	$113.75	$116.85	+2.7%

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

ZIP codes in this locality Copy link

Detroit covers 249 ZIP codes across MI, per the CMS ZIP-to-locality crosswalk (Q3 2021). 8 of them span more than one locality and need ZIP+4 for an exact match.

48005 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 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 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 48180 48183 48184 48185 48186 48187 48188 48189 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 48374 48375 48376 48377 48380 48381 48382 48383 48386 48387 48390 48391 48393 48397 48398 48442 48462

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

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 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 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 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 67)

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

Did this answer your question about Detroit (MI)?

We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.