Medicare payment locality · Q4 2021 release

Wyoming WY Medicare Locality 21

MAC 03602 · Locality 21

This locality's GPCIs are all at or below the national baseline, so services priced with the standard RVU formula usually come out below the national amount 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

1.000

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

Malpractice GPCI

0.841

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 Wyoming Copy link

National and Wyoming 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	Wyoming	Difference
99214	$131.20	$130.42	-0.6%
99213	$92.47	$91.91	-0.6%
99215	$183.19	$182.02	-0.6%
66984	$548.17	$545.23	-0.5%
99204	$169.93	$168.65	-0.8%
92014	$128.41	$128.13	-0.2%
97110	$30.36	$30.25	-0.4%
88305	$71.53	$71.42	-0.2%
97530	$39.43	$39.32	-0.3%
99203	$113.75	$112.92	-0.7%

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

Wyoming covers 198 ZIP codes across WY, per the CMS ZIP-to-locality crosswalk (Q3 2021). 7 of them span more than one locality and need ZIP+4 for an exact match.

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.

82001 82002 82003 82005 82006 82007 82008 82009 82010 82050 82051 82052 82053 82054 82055 82058 82059 82060 82061 82063 82070 82071 82072 82073 82081 82082 82083 82084 82190 82201 82210 82212 82213 82214 82215 82217 82218 82219 82221 82222 82223 82224 82225 82227 82229 82240 82242 82243 82244 82301 82310 82321 82322 82323 82324 82325 82327 82329 82331 82332 82334 82335 82336 82401 82410 82411 82412 82414 82420 82421 82422 82423 82426 82427 82428 82430 82431 82432 82433 82434 82435 82440 82441 82442 82443 82450 82501 82510 82512 82513 82514 82515 82516 82520 82523 82524 82601 82602 82604 82605 82609 82615 82620 82630 82631 82633 82635 82636 82637 82638 82639 82640 82642 82643 82644 82646 82648 82649 82701 82710 82711 82712 82713 82714 82715 82716 82717 82718 82720 82721 82723 82725 82727 82729 82730 82731 82732 82801 82831 82832 82833 82834 82835 82836 82837 82838 82839 82840 82842 82844 82845 82901 82902 82922 82923 82925 82929 82930 82931 82932 82933 82934 82935 82936 82937 82938 82939 82941 82942 82943 82944 82945 83001 83002 83011 83012 83013 83014 83025 83101 83110 83111 83112 83113 83114 83115 83116 83118 83119 83120 83121 83122 83123 83124 83126 83127 83128 83414

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

Common questions Copy link

Why do Medicare rates in Wyoming 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. Wyoming currently has all three GPCIs at or below the national baseline, so services priced with the standard RVU formula usually come out below the national amount 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. About 7 ZIP codes in Wyoming 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 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 115)

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

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