Montana (MT) Medicare rates & GPCIs—Q4 2024

ZIP codes in this locality Copy link

Montana covers 411 ZIP codes across MT, per the CMS ZIP-to-locality crosswalk (Q3 2024). 3 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.

We don't have the Q4 2024 ZIP-to-locality crosswalk file yet; figures are from the Q3 2024 release and may not reflect Q4 2024 changes.

59001
59002
59003
59004
59006
59007
59008 (split ZIP)
59010
59011
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59018
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59020
59022
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59041
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59061
59062
59063
59064
59065
59066
59067
59068
59069
59070
59071
59072
59073

Show all 411 ZIP codes

59074
59075
59076
59077
59078
59079
59081
59082
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59084
59085
59086
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59088
59089
59101
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59270
59273
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59276
59301
59311 (split ZIP)
59312
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59720
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59750
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59830
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59840
59841
59842
59843
59844
59845
59846
59847 (split ZIP)
59848
59851
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59863
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59937

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	1.000	0.998
January 2023 to October 2025 (this page)	1.000	1.000	0.978
January 2021 to October 2022	1.000	1.000	0.977
January 2020 to October 2020	1.000	1.000	1.304
January 2018 to October 2019	1.000	1.000	1.631
January 2017 to October 2017	1.000	1.000	1.429
January 2015 to October 2016	1.000	1.000	1.226
April 2014 to October 2014	1.000	1.000	1.165
January 2013 to April 2013	1.000	1.000	1.103

Example rates in Montana Copy link

National and local Office (non-facility) amounts for frequently reviewed codes in the Q4 2024 release, before sequestration. Conversion factor: 2024 standard (non-QP) physician conversion factor, $33.2875.

Code	National	Local	Difference
99214	$128.16	$128.05	-0.1%
99213	$90.87	$90.80	-0.1%
99215	$180.42	$180.26	-0.1%
66984	$537.26	$536.86	-0.1%
99204	$167.10	$166.93	-0.1%
92014	$125.49	$125.46	0.0%
97110	$29.29	$29.29	0.0%
88305	$71.57	$71.55	0.0%
97530	$36.62	$36.61	0.0%
99203	$111.51	$111.40	-0.1%

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 Montana 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. Montana 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 Q4 2024 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 3 ZIP codes in Montana 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 Q4 2024 release (effective October 2024). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2024 release. Example amounts use the standard (non-QP) physician conversion factor ($33.2875) 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 (Q4 2024) · rvu24d.zip (GPCI2024.csv row 71)

ZIP code to carrier locality crosswalk (Q3 2024) · zip-code-to-carrier-locality.zip (ZIP5_JUL2024.txt)

Montana

Price a code in Montana Copy link

ZIP codes in this locality Copy link

GPCI history Copy link

Example rates in Montana Copy link

Common questions Copy link

Source & method Copy link

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