Medicare payment locality · Q4 2021 release

Virgin Islands VI Medicare Locality 50

MAC 09202 · Locality 50

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

1.000

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.008

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

Malpractice GPCI

0.986

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 Virgin Islands Copy link

National and Virgin Islands Office (non-facility) amounts for frequently reviewed codes in the Q4 2021 release (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	Virgin Islands	Difference
99214	$131.20	$131.60	+0.3%
99213	$92.47	$92.77	+0.3%
99215	$183.19	$183.71	+0.3%
66984	$548.17	$550.10	+0.4%
99204	$169.93	$170.39	+0.3%
92014	$128.41	$129.00	+0.5%
97110	$30.36	$30.46	+0.3%
88305	$71.53	$71.88	+0.5%
97530	$39.43	$39.61	+0.5%
99203	$113.75	$114.10	+0.3%

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

Virgin Islands covers 16 ZIP codes across VI, per the CMS ZIP-to-locality crosswalk (Q3 2021).

We don't have the Q4 2021 ZIP-to-locality crosswalk file yet; figures are from the Q3 2021 release and may not reflect Q4 2021 changes.

00801 00802 00803 00804 00805 00820 00821 00822 00823 00824 00830 00831 00840 00841 00850 00851

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

Common questions Copy link

Why do Medicare rates in Virgin Islands 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. Virgin Islands 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 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 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 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 (Q4 2021) · rvu21d.zip (GPCI2021.csv row 110)

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

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