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The factor determine is the geographic practice cost index or GPCI.
As practice expenses vary from region to region, the Medicare physician fee schedule levels are modified to reflect this. For each of the three elements that make up a procedure's relative value unit, a geographic practice cost index (GPCI) has been produced for each Medicare payment region (i.e., the RVUs for work, practice expense, and malpractice).
By multiplying the RVU for each component by its GPCI, the GPCIs are taken into account for determining the fee schedule payment amount.
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