Price a code in New Mexico Copy link
What common codes pay in New Mexico Copy link
99214 is $120.66 here, 3.6% below national. Across these 10 codes, local Office (non-facility) amounts run from 5.7% below to 3.2% below national, depending on each code's mix of work, practice-expense and malpractice RVUs.
| Code | National | Local | Difference |
|---|---|---|---|
| 99214 | $125.18 | $120.66 | -3.6% |
| 99213 | $88.95 | $85.49 | -3.9% |
| 99215 | $175.64 | $169.61 | -3.4% |
| 66984 | $521.75 | $500.32 | -4.1% |
| 99204 | $163.35 | $158.11 | -3.2% |
| 92014 | $120.98 | $114.41 | -5.4% |
| 97110 | $28.79 | $27.56 | -4.3% |
| 88305 | $69.54 | $65.55 | -5.7% |
| 97530 | $34.61 | $32.82 | -5.2% |
| 99203 | $109.01 | $105.11 | -3.6% |
Office (non-facility), Q1 2025, before sequestration; 2025 standard (non-QP) physician conversion factor $32.3465. For the facility amount, a modifier or a date of service, use the rate calculator, already set to this locality, or start from your field's procedure mix on the specialty fee schedules.
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 costs for physician work, running an office, and liability insurance 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 2025 release.
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.
Which ZIP codes are in New Mexico? Copy link
439 ZIP codes in NM, per the CMS ZIP-to-locality crosswalk (Q1 2025). 1 of them, outlined with a dashed border, span more than one locality: CMS places those by ZIP+4, so this locality holds for only part of each.
- 87001
- 87002
- 87004
- 87005
- 87006
- 87007
- 87008
- 87009
- 87010
- 87011
- 87012
- 87013
- 87014
- 87015
- 87016
- 87017
- 87018
- 87020
- 87021
- 87022
- 87023
- 87024
- 87025
- 87026
Show all 439 ZIP codes
- 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 (split ZIP)
- 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
Have a service address? Look up its ZIP and date of service to confirm the locality.
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 1 ZIP codes in New Mexico span more than one locality and need the ZIP+4 to resolve exactly.
Have its GPCIs changed? Copy link
These GPCIs took effect January 2024: PE 0.902 → 0.908, MP 1.169 → 1.172.
| Release | Work | PE | MP |
|---|---|---|---|
| January 2026 to October 2026 | 1.000 | 0.917 | 1.201 |
| January 2024 to October 2025 (this page) | 1.000 | 0.908 | 1.172 |
| January 2023 to October 2023 | 1.000 | 0.902 | 1.169 |
| January 2021 to October 2022 | 1.000 | 0.896 | 1.166 |
| January 2020 to October 2020 | 1.000 | 0.908 | 1.207 |
| January 2018 to October 2019 | 1.000 | 0.921 | 1.247 |
| January 2017 to October 2017 | 1.000 | 0.920 | 1.204 |
| January 2015 to October 2016 | 1.000 | 0.919 | 1.161 |
| April 2014 to October 2014 | 1.000 | 0.918 | 1.079 |
| January 2013 to April 2013 | 1.000 | 0.916 | 0.997 |
Newest first; releases with unchanged GPCIs share a row.
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
-
01 GPCI2025.csv · Q1 2025 (RVU25A) · row 77—the three GPCIs limits
- Effective
- Effective January 2025
- Locator
- GPCI2025.csv in rvu25a-updated-01-10-2025.zip · row 77 of 109 · via CMS
- Fields read
-
MAC 04212 Locality 05 Work GPCI 1.000 PE GPCI 0.908 MP GPCI 1.172SHA-256 fc106f49547d0821…
- Doesn’t establish
- An amount for any code by itself: that needs the code’s RVUs and status from the same release.
-
02 ZIP5_JAN2025.txt · Q1 2025—439 ZIP codes limits
- Source
- ZIP code to carrier locality crosswalk
- Locator
- ZIP5_JAN2025.txt in 2024.zip · via CMS
- Fields read
-
SHA-256 0e320344c07534f7…
- Doesn’t establish
- Where a split ZIP’s service address falls: CMS places those by ZIP+4.
-
03 Example amounts · Q1 2025 · $32.3465—the common-code table limits
- Source
- Each code’s Office (non-facility) RVUs from the same release, × these GPCIs, × the 2025 standard (non-QP) physician conversion factor
- Effective
- Effective January 2025
- Doesn’t establish
- Facility amounts, modifier adjustments or the payment after the ~2% sequestration cut; codes outside the standard RVU formula aren’t listed.
- Note
- Past releases are never edited, so a rate for an earlier quarter always matches what CMS published for it.
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