Medicare payment locality · Q1 2018 release

Nevada NV Medicare Locality 00

MAC 01312 · Locality 00

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q1 2018 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.002

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.017

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

Malpractice GPCI

0.909

Adjusts the malpractice component using liability-cost data

1.000 is the national baseline. A value above 1.000 raises that component; below 1.000 lowers it. GPCIs are Medicare payment factors, not general cost-of-living or physician-compensation indexes.

Example rates in Nevada Copy link

National and Nevada Office (non-facility) amounts for frequently reviewed codes in the Q1 2018 release (before sequestration). Conversion factor: 2018 standard (non-QP) physician conversion factor · $35.9996.

Code	National	Nevada	Difference
99214	$109.44	$110.10	+0.6%
99213	$74.16	$74.62	+0.6%
99215	$147.60	$148.38	+0.5%
66984	$656.27	$660.50	+0.6%
99204	$167.40	$168.08	+0.4%
92014	$128.52	$129.70	+0.9%
97110	$31.32	$31.53	+0.7%
88305	$70.20	$70.87	+1.0%
97530	$41.40	$41.79	+0.9%
99203	$109.80	$110.32	+0.5%

Need a specific code or the facility amount? Use the rate calculator and choose this locality. Or start with your field's usual procedure mix on the specialty fee schedules.

ZIP codes in this locality Copy link

Nevada covers 257 ZIP codes across NV, per the CMS ZIP-to-locality crosswalk (Q1 2018). 2 of them span more than one locality and need ZIP+4 for an exact match.

88901 88905 89001 89002 89003 89004 89005 89006 89007 89008 89009 89010 89011 89012 89013 89014 89015 89016 89017 89018 89019 89020 89021 89022 89023 89024 89025 89026 89027 89028 89029 89030 89031 89032 89033 89034 89036 89037 89039 89040 89041 89042 89043 89044 89045 89046 89047 89048 89049 89052 89053 89054 89060 89061 89067 89070 89074 89077 89081 89084 89085 89086 89087 89101 89102 89103 89104 89105 89106 89107 89108 89109 89110 89111 89112 89113 89114 89115 89116 89117 89118 89119 89120 89121 89122 89123 89124 89125 89126 89127 89128 89129 89130 89131 89132 89133 89134 89135 89136 89137 89138 89139 89140 89141 89142 89143 89144 89145 89146 89147 89148 89149 89150 89151 89152 89153 89154 89155 89156 89157 89158 89159 89160 89161 89162 89163 89164 89165 89166 89169 89170 89173 89177 89178 89179 89180 89183 89185 89191 89193 89195 89199 89301 89310 89311 89314 89315 89316 89317 89318 89319 89402 89403 89404 89405 89406 89407 89408 89409 89410 89411 89412 89413 89414 89415 89418 89419 89420 89421 89422 89423 89424 89425 89426 89427 89428 89429 89430 89431 89432 89433 89434 89435 89436 89438 89439 89440 89441 89442 89444 89445 89446 89447 89448 89449 89450 89451 89452 89460 89494 89496 89501 89502 89503 89504 89505 89506 89507 89508 89509 89510 89511 89512 89513 89515 89519 89520 89521 89523 89533 89555 89557 89564 89570 89595 89599 89701 89702 89703 89704 89705 89706 89710 89711 89712 89713 89714 89721 89801 89802 89803 89815 89820 89821 89822 89823 89824 89825 89826 89828 89830 89831 89832 89833 89834 89835 89883

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

Common questions Copy link

Why do Medicare rates in Nevada 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. Nevada currently has mixed GPCI components, so the net payment effect varies by code for the Q1 2018 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 2 ZIP codes in Nevada 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 Q1 2018 release (effective January 2018). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q1 2018 release. Example amounts use the standard (non-QP) physician conversion factor ($35.9996) 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 (Q1 2018) · rvu18ar1.zip (GPCI2018.csv row 76)

ZIP code to carrier locality crosswalk (Q1 2018) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JAN18.txt)

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