Two clinics bill the same CPT with identical RVUs, but they are in different Medicare localities. Why might payment differ?
Select an answer to reveal the explanation.
Short Explanation
Same code, same RVU skeleton—different ZIP-code seasoning. GPCIs nudge the RVUs up or down by locality so a service in one Medicare area is not priced exactly like another. Geography is baked into RBRVS on purpose.
Full Explanation
GPCIs adjust RVU components to reflect geographic differences in practice costs across Medicare localities. As a result, identical CPT services can pay differently by locality even when base RVUs match. Understanding GPCI effects helps explain regional payment variation under RBRVS; locality adjustment is not eliminated by a single national conversion factor alone, nor is it driven solely by diagnosis coding.