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Medicare payment locality · Q4 2019 release

Manhattan flag

Manhattan

New York MAC 13202 · Locality 01

Work GPCI
1.052
Practice expense GPCI
1.180
Malpractice GPCI
1.615

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 RVU19D Updated

Price a code in Manhattan Copy link

The locality-adjusted amount for the Q4 2019 release, with the facility and office settings and the full calculation.

ZIP codes in this locality Copy link

Manhattan covers 165 ZIP codes across NY, per the CMS ZIP-to-locality crosswalk (Q3 2019).

We don't have the Q4 2019 ZIP-to-locality crosswalk file yet; figures are from the Q3 2019 release and may not reflect Q4 2019 changes.

  • 10001
  • 10002
  • 10003
  • 10004
  • 10005
  • 10006
  • 10007
  • 10008
  • 10009
  • 10010
  • 10011
  • 10012
  • 10013
  • 10014
  • 10015
  • 10016
  • 10017
  • 10018
  • 10019
  • 10020
  • 10021
  • 10022
  • 10023
  • 10024
  • 10025
  • 10026
  • 10027
  • 10028
  • 10029
  • 10030
  • 10031
  • 10032
  • 10033
  • 10034
  • 10035
  • 10036
  • 10037
  • 10038
  • 10039
  • 10040
  • 10041
  • 10043
  • 10044
  • 10045
  • 10046
  • 10047
  • 10048
  • 10055
  • 10060
  • 10065
  • 10069
  • 10072
  • 10075
  • 10079
  • 10080
  • 10081
  • 10082
  • 10087
  • 10090
  • 10094
Show all 165 ZIP codes
  • 10095
  • 10096
  • 10098
  • 10099
  • 10101
  • 10102
  • 10103
  • 10104
  • 10105
  • 10106
  • 10107
  • 10108
  • 10109
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  • 10111
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  • 10114
  • 10115
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  • 10117
  • 10118
  • 10119
  • 10120
  • 10121
  • 10122
  • 10123
  • 10124
  • 10125
  • 10126
  • 10128
  • 10129
  • 10130
  • 10131
  • 10132
  • 10133
  • 10138
  • 10149
  • 10150
  • 10151
  • 10152
  • 10153
  • 10154
  • 10155
  • 10156
  • 10157
  • 10158
  • 10159
  • 10160
  • 10161
  • 10162
  • 10163
  • 10164
  • 10165
  • 10166
  • 10167
  • 10168
  • 10169
  • 10170
  • 10171
  • 10172
  • 10173
  • 10174
  • 10175
  • 10176
  • 10177
  • 10178
  • 10179
  • 10184
  • 10185
  • 10196
  • 10197
  • 10199
  • 10200
  • 10203
  • 10211
  • 10212
  • 10213
  • 10242
  • 10249
  • 10256
  • 10257
  • 10258
  • 10259
  • 10260
  • 10261
  • 10265
  • 10268
  • 10269
  • 10270
  • 10271
  • 10272
  • 10273
  • 10274
  • 10275
  • 10276
  • 10277
  • 10278
  • 10279
  • 10280
  • 10281
  • 10282
  • 10285
  • 10286
  • 10292

Have a service address? Look up its ZIP and date of service to confirm the locality.

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 1.064 1.162 1.586
January 2024 to October 2025 1.065 1.166 1.656
January 2023 to October 2023 1.061 1.184 1.843
January 2021 to October 2022 1.056 1.203 2.031
January 2020 to October 2020 1.054 1.192 1.823
January 2018 to October 2019 (this page) 1.052 1.180 1.615
January 2017 to October 2017 1.052 1.174 1.690
January 2015 to October 2016 1.052 1.168 1.764
April 2014 to October 2014 1.057 1.165 1.518
January 2013 to April 2013 1.062 1.162 1.271

Example rates in Manhattan Copy link

National and local Office (non-facility) amounts for frequently reviewed codes in the Q4 2019 release, before sequestration. Conversion factor: 2019 standard (non-QP) physician conversion factor, $36.0391.

Code National Local Difference
99214 $110.28 $124.78 +13.1%
99213 $75.32 $85.50 +13.5%
99215 $147.76 $166.98 +13.0%
66984 $654.47 $742.38 +13.4%
99204 $166.86 $188.98 +13.3%
92014 $128.66 $146.21 +13.6%
97110 $31.35 $35.24 +12.4%
88305 $70.28 $79.94 +13.7%
97530 $40.72 $46.34 +13.8%
99203 $109.92 $125.35 +14.0%

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 Manhattan 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. Manhattan 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 Q4 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 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 Q4 2019 release (effective October 2019). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2019 release. Example amounts use the standard (non-QP) physician conversion factor ($36.0391) 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 (Q4 2019) · rvu19d.zip (GPCI2019.csv row 81)
ZIP code to carrier locality crosswalk (Q3 2019) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JUL2019.txt)

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