localis
Calculator

Describe a service in plain words, or type a CPT/HCPCS code.

Medicare payment locality · Q3 2016 release

Northern Nj flag

Northern Nj

New Jersey MAC 12402 · Locality 01

Work GPCI
1.040
Practice expense GPCI
1.182
Malpractice GPCI
1.090

All three GPCIs are at or above the national baseline of 1.000, so codes priced with the standard RVU formula usually pay more here than the national amount.

Effective CMS RVU16C Updated

Price a code in Northern Nj Copy link

The locality-adjusted amount for the Q3 2016 release, with the facility and office settings and the full calculation.

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 1.063 1.160 1.068
January 2024 to October 2025 1.064 1.172 1.032
January 2023 to October 2023 1.056 1.186 0.996
January 2021 to October 2022 1.049 1.199 0.959
January 2020 to October 2020 1.045 1.190 0.949
January 2018 to October 2019 1.041 1.180 0.938
January 2017 to October 2017 1.041 1.181 1.014
January 2015 to October 2016 (this page) 1.040 1.182 1.090
April 2014 to October 2014 1.042 1.184 1.068
January 2013 to April 2013 1.044 1.186 1.045

Example rates in Northern Nj Copy link

National and local Office (non-facility) amounts for frequently reviewed codes in the Q3 2016 release, before sequestration. Conversion factor: 2016 standard (non-QP) physician conversion factor, $35.8043.

Code National Local Difference
99214 $108.13 $119.85 +10.8%
99213 $73.40 $81.60 +11.2%
99215 $145.72 $161.02 +10.5%
66984 $648.42 $721.10 +11.2%
99204 $166.13 $183.29 +10.3%
92014 $124.60 $139.86 +12.2%
97110 $32.58 $36.16 +11.0%
88305 $74.11 $83.69 +12.9%
97530 $35.09 $39.20 +11.7%
99203 $108.85 $120.94 +11.1%

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 Northern Nj 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. Northern Nj currently has all three GPCIs at or above the national baseline, so services priced with the standard RVU formula usually come out above the national amount for the Q3 2016 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. A few ZIPs nationally span multiple localities and need 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 2016 release (effective July 2016). Example amounts use the standard (non-QP) physician conversion factor ($35.8043) 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 2016) · rvu16c.zip (CY2016_GPCIs.csv row 54)

Did this answer your question about Northern Nj (NJ)?

Tell us what you were trying to work out and we'll answer you or build the page that does.

Did this page answer your question?