Medicare payment locality · Q1 2022 release

Queens, Ny NY Medicare Locality 04

MAC 13292 · Locality 04

This locality's GPCIs are all at or above the national baseline, so normally RVU-priced services tend to price above the national amount for the Q1 2022 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

1.228

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

Malpractice GPCI

2.661

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 Queens, Ny Copy link

National vs. Queens, Ny office (non-facility) amounts for frequently reviewed codes, Q1 2022 (before sequestration). Conversion factor: 2022 standard (non-QP) physician conversion factor · $34.6062.

Code	National	Queens, Ny	Difference
99214	$129.77	$153.88	+18.6%
99213	$92.05	$110.26	+19.8%
99215	$183.07	$218.55	+19.4%
66984	$544.70	$652.92	+19.9%
99204	$169.57	$204.66	+20.7%
92014	$128.39	$151.69	+18.1%
97110	$30.11	$35.29	+17.2%
88305	$71.98	$84.92	+18.0%
97530	$38.07	$45.12	+18.5%
99203	$113.85	$138.72	+21.8%

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

Queens, Ny covers 84 ZIP codes across NY, per the CMS ZIP-to-locality crosswalk (Q1 2022). 1 of them span more than one locality and need ZIP+4 for an exact match.

11004 11005 11101 11102 11103 11104 11105 11106 11109 11120 11351 11352 11353 11354 11355 11356 11357 11358 11359 11360 11361 11362 11363 11364 11365 11366 11367 11368 11369 11370 11371 11372 11373 11374 11375 11377 11378 11379 11380 11381 11385 11386 11388 11390 11405 11411 11412 11413 11414 11415 11416 11417 11418 11419 11420 11421 11422 11423 11424 11425 11426 11427 11428 11429 11430 11431 11432 11433 11434 11435 11436 11437 11439 11451 11484 11499 11690 11691 11692 11693 11694 11695 11696 11697

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

Common questions Copy link

Why do Medicare rates in Queens, 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 professional labor, office-input, and liability costs therefore move the final amount up or down. Queens, Ny currently has all three GPCI components at or above the national baseline, so normally RVU-priced services tend to price above the national amount for the Q1 2022 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 Queens, Ny 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 2022 release (effective January 2022). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q1 2022 release . Example amounts use the standard (non-QP) physician conversion factor ($34.6062) 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 2022) · rvu22a.zip (GPCI2022.csv row 84)

ZIP code to carrier locality crosswalk (Q1 2022) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JAN2022.txt)

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