Medicare payment locality · Q2 2023 release

Rhode Island RI Medicare Locality 01

MAC 14412 · Locality 01

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q2 2023 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.023

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.044

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

Malpractice GPCI

0.915

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 Rhode Island Copy link

National vs. Rhode Island office (non-facility) amounts for frequently reviewed codes, Q2 2023 (before sequestration). Conversion factor: 2023 standard (non-QP) physician conversion factor · $33.8872.

Code	National	Rhode Island	Difference
99214	$128.43	$132.11	+2.9%
99213	$90.82	$93.45	+2.9%
99215	$179.94	$184.99	+2.8%
66984	$541.86	$558.06	+3.0%
99204	$167.40	$171.91	+2.7%
92014	$127.08	$131.48	+3.5%
97110	$29.82	$30.77	+3.2%
88305	$71.84	$74.38	+3.5%
97530	$37.61	$38.91	+3.5%
99203	$112.84	$115.93	+2.7%

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

Rhode Island covers 91 ZIP codes across RI, per the CMS ZIP-to-locality crosswalk (Q2 2022).

The Q2 2023 ZIP-to-locality crosswalk file is not on file here; figures are from the Q2 2022 release and may not reflect Q2 2023 revisions.

02801 02802 02804 02806 02807 02808 02809 02812 02813 02814 02815 02816 02817 02818 02822 02823 02824 02825 02826 02827 02828 02829 02830 02831 02832 02833 02835 02836 02837 02838 02839 02840 02841 02842 02852 02854 02857 02858 02859 02860 02861 02862 02863 02864 02865 02871 02872 02873 02874 02875 02876 02877 02878 02879 02880 02881 02882 02883 02885 02886 02887 02888 02889 02891 02892 02893 02894 02895 02896 02898 02901 02902 02903 02904 02905 02906 02907 02908 02909 02910 02911 02912 02914 02915 02916 02917 02918 02919 02920 02921 02940

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

Common questions Copy link

Why do Medicare rates in Rhode Island 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. Rhode Island currently has mixed GPCI components, so the net payment effect varies by code for the Q2 2023 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. 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 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 Q2 2023 release (effective April 2023). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q2 2022 release . Example amounts use the standard (non-QP) physician conversion factor ($33.8872) 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 (Q2 2023) · rvu23b-updated-02-27-2023.zip (GPCI2023.csv row 95)

ZIP code to carrier locality crosswalk (Q2 2022) · Zip-Code-to-Carrier-Locality.zip (ZIP5_APR2022_V2.txt)

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