decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Medicare_Claims_Processing_Manual / Chapter_23 / 30.4
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Article Overview
This Medicare Claims Processing Manual section provides a locality listing used for pricing services paid under the physician fee schedule or services linked to it. It is relevant to billing and reimbursement professionals who need to understand how geographic localities are identified for Medicare payment processing and the scope of CMS authority over locality changes. The article presents the locality framework and the carrier/locality mapping information maintained for payment administration.
Why This Topic Matters
Correct locality identification affects Medicare payment processing for many physician-fee-schedule-based services and related diagnostic services. This section helps users understand the geographic structure used in claims administration and the limits on who may modify locality assignments.
Article Sections
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Localities for Pricing
Introduces the Medicare locality framework used for payment administration and notes the scope of services affected. It also addresses which entities control locality changes.
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LOCALITIES
Provides the locality listing organized by carrier number, locality number, and locality name. The table serves as a reference for geographic payment processing.
What You Will Learn
- How Medicare pricing localities are organized for payment administration
- Which services are tied to physician fee schedule locality rules
- How locality information is presented for carrier and geographic reference
- The role of CMS versus contractors in locality changes
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Compliance professionals
- Medicare reimbursement specialists
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