Medicare payment locality · Q1 2019 release

New Mexico NM Medicare Locality 05

MAC 04212 · Locality 05

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q1 2019 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

0.921

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

Malpractice GPCI

1.247

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 New Mexico Copy link

National vs. New Mexico office (non-facility) amounts for frequently reviewed codes, Q1 2019 (before sequestration). Conversion factor: 2019 standard (non-QP) physician conversion factor · $36.0391.

Code	National	New Mexico	Difference
99214	$110.28	$107.01	-3.0%
99213	$75.32	$72.96	-3.1%
99215	$147.76	$143.86	-2.6%
66984	$654.47	$634.07	-3.1%
99204	$166.86	$163.06	-2.3%
92014	$128.66	$123.24	-4.2%
97110	$31.35	$30.39	-3.1%
88305	$70.28	$67.21	-4.4%
97530	$40.72	$38.99	-4.2%
99203	$109.92	$106.92	-2.7%

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

New Mexico covers 439 ZIP codes across NM, per the CMS ZIP-to-locality crosswalk (Q1 2019). 1 of them span more than one locality and need ZIP+4 for an exact match.

87001 87002 87004 87005 87006 87007 87008 87009 87010 87011 87012 87013 87014 87015 87016 87017 87018 87020 87021 87022 87023 87024 87025 87026 87027 87028 87029 87031 87032 87034 87035 87036 87037 87038 87040 87041 87042 87043 87044 87045 87046 87047 87048 87049 87051 87052 87053 87056 87057 87059 87060 87061 87062 87063 87064 87068 87070 87072 87083 87101 87102 87103 87104 87105 87106 87107 87108 87109 87110 87111 87112 87113 87114 87115 87116 87117 87118 87119 87120 87121 87122 87123 87124 87125 87131 87140 87144 87151 87153 87154 87158 87165 87174 87176 87180 87181 87184 87185 87187 87190 87191 87192 87193 87194 87195 87196 87197 87198 87199 87201 87300 87301 87302 87305 87310 87311 87312 87313 87315 87316 87317 87319 87320 87321 87322 87323 87325 87326 87327 87328 87347 87357 87364 87365 87375 87401 87402 87410 87412 87413 87415 87416 87417 87418 87419 87420 87421 87455 87461 87499 87500 87501 87502 87503 87504 87505 87506 87507 87508 87509 87510 87511 87512 87513 87514 87515 87516 87517 87518 87519 87520 87521 87522 87523 87524 87525 87527 87528 87529 87530 87531 87532 87533 87535 87537 87538 87539 87540 87543 87544 87545 87547 87548 87549 87551 87552 87553 87554 87556 87557 87558 87560 87562 87564 87565 87566 87567 87569 87571 87573 87574 87575 87576 87577 87578 87579 87580 87581 87582 87583 87592 87594 87654 87701 87710 87711 87712 87713 87714 87715 87718 87722 87723 87724 87728 87729 87730 87731 87732 87733 87734 87735 87736 87740 87742 87743 87745 87746 87747 87749 87750 87752 87753 87801 87820 87821 87823 87824 87825 87827 87828 87829 87830 87831 87832 87901 87910 87930 87931 87933 87935 87936 87937 87939 87940 87941 87942 87943 88001 88002 88003 88004 88005 88006 88007 88008 88009 88011 88012 88013 88020 88021 88022 88023 88024 88025 88026 88027 88028 88029 88030 88031 88032 88033 88034 88036 88038 88039 88040 88041 88042 88043 88044 88045 88046 88047 88048 88049 88051 88052 88053 88054 88055 88056 88058 88061 88062 88063 88065 88072 88081 88101 88102 88103 88112 88113 88114 88115 88116 88118 88119 88120 88121 88122 88123 88124 88125 88126 88130 88132 88133 88134 88135 88136 88201 88202 88203 88210 88211 88213 88220 88221 88230 88231 88232 88240 88241 88242 88244 88250 88252 88253 88254 88255 88256 88260 88262 88263 88264 88265 88267 88268 88301 88310 88311 88312 88314 88316 88317 88318 88321 88323 88324 88325 88330 88336 88337 88338 88339 88340 88341 88342 88343 88344 88345 88346 88347 88348 88349 88350 88351 88352 88353 88354 88355 88401 88410 88411 88414 88415 88416 88417 88418 88419 88421 88422 88424 88426 88427 88429 88430 88431 88433 88434 88435 88436 88437 88439 88441

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

Common questions Copy link

Why do Medicare rates in New Mexico 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. New Mexico currently has mixed GPCI components, so the net payment effect varies by code for the Q1 2019 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 1 ZIP codes in New Mexico 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 2019 release (effective January 2019). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q1 2019 release . Example amounts use the standard (non-QP) physician conversion factor ($36.0391) 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 2019) · rvu19a.zip (GPCI2019.csv row 80)

ZIP code to carrier locality crosswalk (Q1 2019) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JAN2019.txt)

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