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Medicare payment locality · Q3 2018 release

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Austin

Texas MAC 04412 · Locality 31

Work GPCI
1.000
Practice expense GPCI
1.021
Malpractice GPCI
0.747

The GPCIs fall on both sides of the national baseline of 1.000, so whether a code pays more or less here depends on its mix of work, practice-expense and malpractice RVUs.

Effective CMS RVU18C Updated

Price a code in Austin Copy link

The locality-adjusted amount for the Q3 2018 release, with the facility and office settings and the full calculation.

ZIP codes in this locality Copy link

Austin covers 89 ZIP codes across TX, per the CMS ZIP-to-locality crosswalk (Q3 2018). 10 of them, outlined with a dashed border below, span more than one locality: CMS places those by ZIP+4, so this locality holds for only part of each.

  • 73301
  • 73344
  • 78617 (split ZIP)
  • 78645
  • 78651
  • 78652 (split ZIP)
  • 78653 (split ZIP)
  • 78660
  • 78669 (split ZIP)
  • 78691
  • 78701
  • 78702
  • 78703
  • 78704
  • 78705
  • 78708
  • 78709
  • 78710
  • 78711
  • 78712
  • 78713
  • 78714
  • 78715
  • 78716
  • 78718
  • 78719
  • 78720
  • 78721
  • 78722
  • 78723
  • 78724
  • 78725
  • 78726
  • 78727 (split ZIP)
  • 78728 (split ZIP)
  • 78730
  • 78731
  • 78732
  • 78733
  • 78734
  • 78735
  • 78736 (split ZIP)
  • 78738 (split ZIP)
  • 78739
  • 78741
  • 78742
  • 78744
  • 78745
  • 78746
  • 78747
  • 78748
  • 78749
  • 78750 (split ZIP)
  • 78751
  • 78752
  • 78753
  • 78754
  • 78755
  • 78756
  • 78757
Show all 89 ZIP codes
  • 78758
  • 78759 (split ZIP)
  • 78760
  • 78761
  • 78762
  • 78763
  • 78764
  • 78765
  • 78766
  • 78767
  • 78768
  • 78769
  • 78771
  • 78772
  • 78773
  • 78774
  • 78778
  • 78779
  • 78780
  • 78781
  • 78782
  • 78783
  • 78785
  • 78786
  • 78787
  • 78788
  • 78789
  • 78798
  • 78799

Have a service address? Look up its ZIP and date of service to confirm the locality.

GPCI history Copy link

This locality's GPCIs in each release on file, newest first. Releases with unchanged GPCIs share a row.

Release Work PE MP
January 2026 to October 2026 1.002 1.058 0.886
January 2024 to October 2025 1.000 1.046 0.914
January 2023 to October 2023 1.000 1.053 0.727
January 2021 to October 2022 1.000 1.059 0.539
January 2020 to October 2020 1.000 1.040 0.643
January 2018 to October 2019 (this page) 1.000 1.021 0.747
January 2017 to October 2017 1.000 1.020 0.757
January 2015 to October 2016 1.000 1.019 0.766
April 2014 to October 2014 1.000 1.014 0.759
January 2013 to April 2013 1.000 1.009 0.751

Example rates in Austin Copy link

National and local Office (non-facility) amounts for frequently reviewed codes in the Q3 2018 release, before sequestration. Conversion factor: 2018 standard (non-QP) physician conversion factor, $35.9996.

Code National Local Difference
99214 $109.44 $109.62 +0.2%
99213 $74.16 $74.29 +0.2%
99215 $147.60 $147.62 0.0%
66984 $656.27 $657.70 +0.2%
99204 $167.40 $166.91 -0.3%
92014 $128.52 $129.55 +0.8%
97110 $31.32 $31.44 +0.4%
88305 $70.20 $70.81 +0.9%
97530 $41.40 $41.74 +0.8%
99203 $109.80 $109.55 -0.2%

Need the facility amount, a modifier, or a date of service? Use the rate calculator, already set to this locality. Or start with your field's usual procedure mix on the specialty fee schedules.

Common questions Copy link

Why do Medicare rates in Austin 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. Austin currently has mixed GPCI components, so the net payment effect varies by code for the Q3 2018 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. About 10 ZIP codes in Austin 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 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 Q3 2018 release (effective July 2018). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2018 release. Example amounts use the standard (non-QP) physician conversion factor ($35.9996) 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 (Q3 2018) · rvu18c1.zip (GPCI2018.csv row 99)
ZIP code to carrier locality crosswalk (Q3 2018) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JUL18.txt)

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