Medicare payment locality · Q4 2019 release

South Dakota SD Medicare Locality 02

MAC 03402 · Locality 02

This locality's GPCIs are all at or below the national baseline, so normally RVU-priced services tend to price below the national amount for the Q4 2019 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

1.000

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

Malpractice GPCI

0.389

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 South Dakota Copy link

National vs. South Dakota office (non-facility) amounts for frequently reviewed codes, Q4 2019 (before sequestration). Conversion factor: 2019 standard (non-QP) physician conversion factor · $36.0391.

Code	National	South Dakota	Difference
99214	$110.28	$108.08	-2.0%
99213	$75.32	$73.78	-2.0%
99215	$147.76	$144.46	-2.2%
66984	$654.47	$641.26	-2.0%
99204	$166.86	$162.24	-2.8%
92014	$128.66	$127.34	-1.0%
97110	$31.35	$30.91	-1.4%
88305	$70.28	$69.62	-0.9%
97530	$40.72	$40.28	-1.1%
99203	$109.92	$106.84	-2.8%

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

South Dakota covers 418 ZIP codes across SD, per the CMS ZIP-to-locality crosswalk (Q3 2019). 24 of them span more than one locality and need ZIP+4 for an exact match.

The Q4 2019 ZIP-to-locality crosswalk file is not on file here; figures are from the Q3 2019 release and may not reflect Q4 2019 revisions.

57001 57002 57003 57004 57005 57006 57007 57010 57012 57013 57014 57015 57016 57017 57018 57020 57021 57022 57024 57025 57026 57027 57028 57029 57030 57031 57032 57033 57034 57035 57036 57037 57038 57039 57040 57041 57042 57043 57044 57045 57046 57047 57048 57049 57050 57051 57052 57053 57054 57055 57056 57057 57058 57059 57061 57062 57063 57064 57065 57066 57067 57068 57069 57070 57071 57072 57073 57074 57075 57076 57077 57078 57079 57101 57103 57104 57105 57106 57107 57108 57109 57110 57115 57117 57118 57186 57188 57189 57192 57193 57194 57195 57196 57197 57198 57201 57202 57212 57213 57214 57216 57217 57218 57219 57220 57221 57223 57224 57225 57226 57227 57231 57232 57233 57234 57235 57236 57237 57238 57239 57241 57242 57243 57244 57245 57246 57247 57248 57249 57251 57252 57253 57255 57256 57257 57258 57259 57260 57261 57262 57263 57264 57265 57266 57268 57269 57270 57271 57272 57273 57274 57276 57278 57279 57301 57311 57312 57313 57314 57315 57317 57319 57321 57322 57323 57324 57325 57326 57328 57329 57330 57331 57332 57334 57335 57337 57339 57340 57341 57342 57344 57345 57346 57348 57349 57350 57353 57354 57355 57356 57357 57358 57359 57361 57362 57363 57364 57365 57366 57367 57368 57369 57370 57371 57373 57374 57375 57376 57379 57380 57381 57382 57383 57384 57385 57386 57399 57401 57402 57420 57421 57422 57424 57426 57427 57428 57429 57430 57432 57433 57434 57435 57436 57437 57438 57439 57440 57441 57442 57445 57446 57448 57449 57450 57451 57452 57454 57455 57456 57457 57460 57461 57462 57465 57466 57467 57468 57469 57470 57471 57472 57473 57474 57475 57476 57477 57479 57481 57501 57520 57521 57522 57523 57526 57528 57529 57531 57532 57533 57534 57536 57537 57538 57540 57541 57542 57543 57544 57547 57548 57551 57552 57553 57555 57557 57559 57560 57562 57563 57564 57566 57567 57568 57569 57570 57571 57572 57574 57576 57577 57578 57579 57580 57584 57585 57601 57620 57621 57622 57623 57625 57626 57628 57629 57630 57631 57632 57633 57634 57636 57638 57639 57640 57641 57642 57643 57644 57645 57646 57647 57648 57649 57650 57651 57652 57653 57656 57657 57658 57659 57660 57661 57701 57702 57703 57706 57708 57709 57714 57716 57717 57718 57719 57720 57722 57724 57725 57729 57730 57732 57735 57736 57737 57738 57741 57742 57744 57745 57747 57748 57750 57751 57752 57754 57755 57756 57758 57759 57760 57761 57762 57763 57764 57765 57766 57767 57769 57770 57772 57773 57774 57775 57776 57777 57778 57779 57780 57782 57783 57785 57787 57788 57790 57791 57792 57793 57794 57799

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

Common questions Copy link

Why do Medicare rates in South Dakota 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. South Dakota currently has all three GPCI components at or below the national baseline, so normally RVU-priced services tend to price below the national amount for the Q4 2019 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 24 ZIP codes in South Dakota 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 2019 release (effective October 2019). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2019 release . Example amounts use the standard (non-QP) physician conversion factor ($36.0391) 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 2019) · rvu19d.zip (GPCI2019.csv row 97)

ZIP code to carrier locality crosswalk (Q3 2019) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JUL2019.txt)

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