Medicare payment locality · Q4 2021 release

Portland, Or OR Medicare Locality 01

MAC 02302 · Locality 01

This locality's GPCIs are mixed, so the net payment effect varies by code 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

1.022

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.063

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

Malpractice GPCI

0.535

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 Portland, Or Copy link

National vs. Portland, Or office (non-facility) amounts for frequently reviewed codes, Q4 2021 (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	Portland, Or	Difference
99214	$131.20	$134.14	+2.2%
99213	$92.47	$94.59	+2.3%
99215	$183.19	$186.85	+2.0%
66984	$548.17	$562.43	+2.6%
99204	$169.93	$172.68	+1.6%
92014	$128.41	$133.54	+4.0%
97110	$30.36	$31.26	+3.0%
88305	$71.53	$74.60	+4.3%
97530	$39.43	$40.92	+3.8%
99203	$113.75	$115.87	+1.9%

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

Portland, Or covers 119 ZIP codes across OR, per the CMS ZIP-to-locality crosswalk (Q3 2021). 4 of them span more than one locality and need ZIP+4 for an exact match.

The Q4 2021 ZIP-to-locality crosswalk file is not on file here; figures are from the Q3 2021 release and may not reflect Q4 2021 revisions.

97003 97004 97005 97006 97007 97008 97009 97010 97011 97013 97015 97017 97019 97022 97023 97024 97027 97028 97030 97034 97035 97036 97038 97042 97045 97049 97055 97060 97062 97067 97068 97070 97075 97076 97077 97078 97079 97080 97086 97089 97106 97109 97113 97116 97117 97119 97123 97124 97125 97129 97133 97140 97144 97200 97201 97202 97203 97204 97205 97206 97207 97208 97209 97210 97211 97212 97213 97214 97215 97216 97217 97218 97219 97220 97221 97222 97223 97224 97225 97227 97228 97229 97230 97231 97232 97233 97236 97238 97239 97240 97242 97250 97251 97252 97253 97254 97255 97256 97258 97259 97266 97267 97268 97269 97271 97272 97280 97281 97282 97283 97286 97290 97291 97292 97293 97294 97296 97298 97299

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

Common questions Copy link

Why do Medicare rates in Portland, Or 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. Portland, Or currently has mixed GPCI components, so the net payment effect varies by code 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 service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. About 4 ZIP codes in Portland, Or 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 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 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 (Q4 2021) · rvu21d.zip (GPCI2021.csv row 90)

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

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