Medicare PFS Locality Configuration

Medicare PFS Locality Configuration

The current Physician Fee Schedule (PFS) locality structure was implemented in 2017 in accordance with the Protecting Access to Medicare Act of 2014 (PAMA 2014). Section 220(b) of that legislation added section 1848(e)(6) of the Act, which requires that, for services furnished on or after January 1, 2017, the locality definitions for California be based on the Metropolitan Statistical Area (MSA) delineations as defined by the Office of Management and Budget (OMB). The resulting modifications to California’s locality structure increased its number of localities from 9 under the previous structure to 27 under the MSA-based locality structure (operational note: for the purposes of payment the actual number of localities under the MSA-based locality structure is 32). Additionally, for some of these new localities, PAMA required that the GPCI values realized under the new MSA-based locality structure be gradually phased in (in one-sixth increments) over a period of six years. As a result of these changes to the locality structure, there are were currently 112 total PFS localities; 34 localities are statewide areas (that is, only one locality for the entire state). There are were 75 localities in the other 16 states, with 10 states having 2 localities, 2 states having 3 localities, 1 state having 4 localities, and 3 states having 5 or more localities. The District of Columbia, Maryland, and Virginia suburbs, Puerto Rico, and the Virgin Islands are additional localities that make up the remainder of the total of 112 localities.

For CY 2024, CMS finalized a policy to retire three California localities that are no longer operationally necessary (87 FR 69621). The Los Angeles-Long Beach-Anaheim MSA, containing Orange County and Los Angeles County, will now be represented by one unique locality number, 18, as opposed to two, thus retiring locality number 26, as it is no longer needed. Similarly, the San Francisco-Oakland-Berkeley MSA containing San Francisco, San Mateo, Alameda, and Contra Costa counties will be represented by one unique locality number, 05, as opposed to three, thus retiring locality numbers 06 and 07. Therefore, for CY 2024, there are 29 PFS localities in California, and 109 total PFS localities.

A listing of the current PFS locality structure, including state, locality area (and when applicable, counties assigned to each locality area) may be accessed in the download section below or on the Locality Key page. Please note that the current listing reflects the CY 2024 California locality changes and several recent naming convention changes to the California MSAs; however, the constituent counties remain the same.

View past Locality Configuration & Studies.

Page Last Modified:
06/04/2024 09:06 AM