Medicare payment locality · Q1 2020 release

Ohio OH Medicare Locality 00

MAC 15202 · Locality 00

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q1 2020 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.000

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

0.915

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

Malpractice GPCI

1.049

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 Ohio Copy link

National and Ohio Office (non-facility) amounts for frequently reviewed codes in the Q1 2020 release (before sequestration). Conversion factor: 2020 standard (non-QP) physician conversion factor · $36.0896.

Code	National	Ohio	Difference
99214	$110.43	$106.18	-3.8%
99213	$76.15	$73.04	-4.1%
99215	$148.33	$142.92	-3.6%
66984	$557.58	$535.30	-4.0%
99204	$167.09	$161.41	-3.4%
92014	$128.12	$121.83	-4.9%
97110	$31.40	$30.21	-3.8%
88305	$71.46	$67.78	-5.1%
97530	$40.42	$38.43	-4.9%
99203	$109.35	$105.04	-3.9%

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

Ohio covers 1,487 ZIP codes across OH, per the CMS ZIP-to-locality crosswalk (Q1 2020).

43001 43002 43003 43004 43005 43006 43007 43008 43009 43010 43011 43013 43014 43015 43016 43017 43018 43019 43021 43022 43023 43025 43026 43027 43028 43029 43030 43031 43032 43033 43035 43036 43037 43040 43041 43044 43045 43046 43047 43048 43050 43054 43055 43056 43058 43060 43061 43062 43064 43065 43066 43067 43068 43069 43070 43071 43072 43073 43074 43076 43077 43078 43080 43081 43082 43083 43084 43085 43086 43093 43098 43099 43101 43102 43103 43105 43106 43107 43109 43110 43111 43112 43113 43115 43116 43117 43119 43123 43125 43126 43127 43128 43130 43135 43136 43137 43138 43140 43142 43143 43144 43145 43146 43147 43148 43149 43150 43151 43152 43153 43154 43155 43156 43157 43158 43160 43162 43163 43164 43194 43195 43196 43198 43199 43201 43202 43203 43204 43205 43206 43207 43209 43210 43211 43212 43213 43214 43215 43216 43217 43218 43219 43220 43221 43222 43223 43224 43226 43227 43228 43229 43230 43231 43232 43234 43235 43236 43240 43251 43253 43260 43265 43266 43267 43268 43269 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Not sure which locality your ZIP is in? Look it up by ZIP code.

Common questions Copy link

Why do Medicare rates in Ohio 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. Ohio currently has mixed GPCI components, so the net payment effect varies by code for the Q1 2020 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 Q1 2020 release (effective January 2020). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q1 2020 release. Example amounts use the standard (non-QP) physician conversion factor ($36.0896) 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 2020) · rvu20a-updated-01312020.zip (GPCI2020.csv row 87)

ZIP code to carrier locality crosswalk (Q1 2020) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JAN2020.txt)

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