Medicare payment locality · Q4 2021 release

Manhattan, Ny NY Medicare Locality 01

MAC 13202 · Locality 01

This locality's GPCIs are all at or above the national baseline, so services priced with the standard RVU formula usually come out above the national amount for the Q4 2021 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.056

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.203

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

Malpractice GPCI

2.031

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 Manhattan, Ny Copy link

National and Manhattan, Ny Office (non-facility) amounts for frequently reviewed codes in the Q4 2021 release (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	Manhattan, Ny	Difference
99214	$131.20	$152.03	+15.9%
99213	$92.47	$107.46	+16.2%
99215	$183.19	$212.08	+15.8%
66984	$548.17	$637.06	+16.2%
99204	$169.93	$197.73	+16.4%
92014	$128.41	$148.63	+15.7%
97110	$30.36	$34.79	+14.6%
88305	$71.53	$82.78	+15.7%
97530	$39.43	$45.75	+16.0%
99203	$113.75	$132.97	+16.9%

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

Manhattan, Ny covers 165 ZIP codes across NY, per the CMS ZIP-to-locality crosswalk (Q3 2021).

We don't have the Q4 2021 ZIP-to-locality crosswalk file yet; figures are from the Q3 2021 release and may not reflect Q4 2021 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 10095 10096 10098 10099 10101 10102 10103 10104 10105 10106 10107 10108 10109 10110 10111 10112 10113 10114 10115 10116 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

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

Common questions Copy link

Why do Medicare rates in Manhattan, Ny 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, Ny 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 2021 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 2021 release (effective October 2021). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2021 release. Example amounts use the standard (non-QP) physician conversion factor ($34.8931) 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 2021) · rvu21d.zip (GPCI2021.csv row 81)

ZIP code to carrier locality crosswalk (Q3 2021) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JUL2021.txt)

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