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PFS Localities Viewer

Complete guide to viewing and searching Medicare Physician Fee Schedule (PFS) Localities and Geographic Practice Cost Indices (GPCI).

Overview

The PFS Localities Viewer provides access to the geographic adjustment factors used in Medicare payment calculations. Medicare payments are adjusted geographically to reflect the varying costs of providing services in different areas (localities).

Access: Navigate to Pricing Data → Carrier-Localities from the dashboard sidebar.

PFS Localities Viewer Main View

Data Coverage: - GPCI Values: Work, Practice Expense, and Malpractice indices - Localities: Geographic areas defined by CMS - MACs: Medicare Administrative Contractors assignments - History: Annual data updates

Understanding GPCI Data

What are GPCIs?

Geographic Practice Cost Indices (GPCIs) are used to adjust the Relative Value Units (RVUs) of a procedure based on the cost of practice in a specific area. There are three types of GPCI:

GPCI Type Description Impact
Work GPCI Adjusts for the relative cost of physician work (time, skill, effort) in an area. Affects the Work RVU component
PE GPCI Practice Expense GPCI. Adjusts for the cost of maintaining a practice (rent, staff, supplies). Affects the Practice Expense RVU component
MP GPCI Malpractice GPCI. Adjusts for the cost of professional liability insurance. Affects the Malpractice RVU component

Payment Calculation Formula

The GPCI values are applied to the RVUs using the following formula:

\text{Payment} = [(\text{Work RVU} \times \text{Work GPCI}) + (\text{PE RVU} \times \text{PE GPCI}) + (\text{MP RVU} \times \text{MP GPCI})] \times \text{Conversion Factor}

Using the Viewer

Search and Filters

The viewer offers multiple ways to find specific locality data:

1. Text Search - Search by locality name (e.g., "San Francisco", "New York") - Search by MAC description (e.g., "Noridian", "Novitas")

2. Locality Code Filter - Enter a specific 7-digit locality code (e.g., 0111205) - Useful for precise lookups when the code is known

3. Year Filter - Select a specific year to view historical data - Defaults to "All Years" if not selected

4. MAC Filter - Filter by Medicare Administrative Contractor - List updates based on the selected year

Results Table

The results table displays the following information:

Column Description
Year The calendar year for the data
Locality Code Unique 7-digit code identifying the area
Description Name of the locality (e.g., "LOS ANGELES, CA")
MAC Contractor code and name
Work GPCI Geographic adjustment for physician work
PE GPCI Geographic adjustment for practice expense
MP GPCI Geographic adjustment for malpractice
Period Valid date range for these values
Status Active (currently valid) or Inactive

PFS Localities Viewer Search Results

Viewing Details

Click the View button on any row to open a detailed modal containing: - Full locality and MAC descriptions - Precise GPCI values (up to 3 decimal places) - Exact start and end dates - Record metadata

PFS Localities Viewer Details

Common Use Cases

1. Pricing Calculations

Scenario: You need to calculate the allowable reimbursement for a procedure in a specific city. 1. Search for the city name (e.g., "Seattle"). 2. Identify the correct locality record for the current year. 3. Note the Work, PE, and MP GPCI values. 4. Apply these values to the procedure's RVUs using the formula above.

2. Verifying MAC Jurisdiction

Scenario: You need to know which MAC covers a specific area. 1. Search for the area name. 2. The "MAC" column displays the contractor code (e.g., 01112) and name.

3. Historical Analysis

Scenario: You are auditing claims from a previous year. 1. Select the specific year from the Year filter. 2. Search for the locality. 3. Use the GPCI values from that specific year to verify payment accuracy.

Data Freshness

Update Frequency: Annually (typically in January)

Source: CMS Physician Fee Schedule Look-Up Tool and public data files.

Note: GPCI values can change annually based on CMS updates. Always ensure you are viewing the data for the correct year matching your date of service.