Medicare payment locality · Q1 2021 release

North Dakota ND Medicare Locality 01

MAC 03302 · Locality 01

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 Q1 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

1.000

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

Malpractice GPCI

0.431

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 North Dakota Copy link

National vs. North Dakota office (non-facility) amounts for frequently reviewed codes, Q1 2021 (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	North Dakota	Difference
99214	$131.20	$128.42	-2.1%
99213	$92.47	$90.48	-2.2%
99215	$183.19	$179.02	-2.3%
66984	$548.17	$537.65	-1.9%
99204	$169.93	$165.36	-2.7%
92014	$128.41	$127.41	-0.8%
97110	$30.36	$29.96	-1.3%
88305	$71.53	$71.13	-0.6%
97530	$39.43	$39.03	-1.0%
99203	$113.75	$110.77	-2.6%

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

North Dakota covers 419 ZIP codes across ND, per the CMS ZIP-to-locality crosswalk (Q1 2021). 12 of them span more than one locality and need ZIP+4 for an exact match.

58001 58002 58004 58005 58006 58007 58008 58009 58011 58012 58013 58014 58015 58016 58017 58018 58021 58027 58029 58030 58031 58032 58033 58035 58036 58038 58039 58040 58041 58042 58043 58045 58046 58047 58048 58049 58051 58052 58053 58054 58056 58057 58058 58059 58060 58061 58062 58063 58064 58065 58067 58068 58069 58071 58072 58074 58075 58076 58077 58078 58079 58081 58102 58103 58104 58105 58106 58107 58108 58109 58121 58122 58123 58124 58125 58126 58201 58202 58203 58204 58205 58206 58207 58208 58210 58212 58213 58214 58216 58218 58219 58220 58222 58223 58224 58225 58227 58228 58229 58230 58231 58233 58235 58236 58237 58238 58239 58240 58241 58243 58244 58249 58250 58251 58254 58255 58256 58257 58258 58259 58260 58261 58262 58265 58266 58267 58269 58270 58271 58272 58273 58274 58275 58276 58277 58278 58281 58282 58301 58310 58311 58313 58316 58317 58318 58319 58320 58321 58323 58324 58325 58327 58329 58330 58331 58332 58335 58337 58338 58339 58341 58343 58344 58345 58346 58348 58351 58352 58353 58355 58356 58357 58359 58361 58362 58363 58365 58366 58367 58368 58369 58370 58372 58374 58377 58379 58380 58381 58382 58384 58385 58386 58401 58402 58405 58413 58415 58416 58418 58420 58421 58422 58423 58424 58425 58426 58428 58429 58430 58431 58432 58433 58436 58438 58439 58440 58441 58442 58443 58444 58445 58448 58451 58452 58454 58455 58456 58458 58460 58461 58463 58464 58466 58467 58472 58474 58475 58476 58477 58478 58479 58480 58481 58482 58483 58484 58486 58487 58488 58489 58490 58492 58494 58495 58496 58497 58501 58502 58503 58504 58505 58506 58507 58520 58521 58523 58524 58528 58529 58530 58531 58532 58533 58535 58538 58540 58541 58542 58544 58545 58549 58552 58553 58554 58558 58559 58560 58561 58562 58563 58564 58565 58566 58568 58569 58570 58571 58572 58573 58575 58576 58577 58579 58580 58581 58601 58602 58620 58621 58622 58623 58625 58626 58627 58630 58631 58632 58634 58636 58638 58639 58640 58641 58642 58643 58644 58645 58646 58647 58649 58650 58651 58652 58653 58654 58655 58656 58701 58702 58703 58704 58705 58707 58710 58711 58712 58713 58716 58718 58721 58722 58723 58725 58727 58730 58731 58733 58734 58735 58736 58737 58740 58741 58744 58746 58747 58748 58750 58752 58755 58756 58757 58758 58759 58760 58761 58762 58763 58765 58768 58769 58770 58771 58772 58773 58775 58776 58778 58779 58781 58782 58783 58784 58785 58787 58788 58789 58790 58792 58793 58794 58795 58801 58802 58803 58830 58831 58833 58835 58838 58843 58844 58845 58847 58849 58852 58853 58854 58856

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

Common questions Copy link

Why do Medicare rates in North Dakota 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. North Dakota 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 Q1 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 service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. About 12 ZIP codes in North Dakota 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 Q1 2021 release (effective January 2021). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q1 2021 release . Example amounts use the standard (non-QP) physician conversion factor ($34.8931) 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 (Q1 2021) · rvu21a-updated-01052021.zip (GPCI2021.csv row 87)

ZIP code to carrier locality crosswalk (Q1 2021) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JAN2021.txt)

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