How Geographic Location Directly Affects Your Reimbursement
Medical reimbursement under Medicare and Florida PIP is not a single statewide amount. Instead reimbursement is based on Medicare fee schedule localities which adjust payment amounts depending on the county where the provider is located. These geographic adjustments directly affect how much an insurer is required to reimburse for medical services.
Florida Medicare Fee Schedule Localities
CMS divides Florida into multiple Medicare payment localities. Each locality has its own reimbursement rates and insurers must use the locality that corresponds to the county where services were rendered.
Florida Medicare Locality Table
| Medicare Locality | Counties Included |
| Locality 03 | Broward Collier Indian River Lee Martin Palm Beach St Lucie |
| Locality 04 | Dade Monroe |
| Locality 99 Subarea 01 | Bay Bradford Calhoun Citrus Columbia De Soto Dixie Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hernando Highlands Holmes Jackson Jefferson Lafayette Lake Levy Liberty Madison Marion Nassau Okaloosa Pasco Putnam Sumter Suwannee Taylor Wakulla Walton Washington |
| Locality 99 Subarea 02 | Alachua Baker Brevard Charlotte Clay Duval Escambia Hardee Hendry Hillsborough Leon Manatee Okeechobee Orange Osceola Pinellas Polk Santa Rosa Sarasota Seminole St Johns Union Volusia |
Each county listed above must be reimbursed using the specific Medicare fee schedule assigned to that locality and subarea. Insurers may not substitute a different locality or apply a statewide average.
Why This Table Matters for Reimbursement
Under section 627.736 subsection 5 paragraph a Florida Statutes an insurer may limit reimbursement to 80 percent of 200 percent of the applicable Medicare Part B fee schedule.
The word applicable means the insurer must use
• the correct Medicare year
• the correct locality
• the correct county designation
Using the wrong locality results in an incorrect reimbursement even if the CPT code and date of service are correct.
Practical Takeaway for Providers
Your county location alone can change your reimbursement amount. Two providers billing the same CPT code on the same date of service may receive different payments solely because they fall under different Medicare localities.
For Florida PIP claims always confirm that the insurer used the correct locality from the table above and calculated reimbursement based on the proper Medicare fee schedule.
Note: This article is for general educational purposes only and does not constitute legal or billing advice. Reimbursement determinations depend on policy language date of service and applicable statutes.
