L1: Physical location

Resolve geographic and regulatory context from a CCN — GPCI values, MAC jurisdiction, Medicaid program, and timely filing rules

Layer 1 extracts the state code from the first two digits of a CCN and resolves all location-dependent billing context. This is the foundation layer — every other layer builds on it.

How it works

A CCN’s first two digits encode the state:

CCN: 170001
      ^^
      17 → Kansas (KS)

From the state, L1 resolves geographic adjustments (GPCI), the Medicare Administrative Contractor (MAC) that processes claims, the state Medicaid program, and filing deadlines.

Request

curl https://api-dev.rcintell.com/v1/knowledge/layers/170001/l1 \
  -H "X-API-Key: $RCI_API_KEY"

Response

{
  "layer": "l1_location",
  "data": {
    "ccn": "170001",
    "state_code": "17",
    "state": "KS",
    "facility_type_code": "00",
    "facility_type": "Short-Term Acute Care Hospital",
    "gpci": {
      "pw_gpci": 1.0,
      "pe_gpci": 0.904,
      "mp_gpci": 0.504
    },
    "government_alignment": {
      "ab_mac": "Jurisdiction 5 (J5)",
      "ab_mac_contractor": "Wisconsin Physicians Service (WPS)",
      "contractor_id": "05202",
      "dme_mac": "Jurisdiction D (JD) - Noridian",
      "hh_mac": "Jurisdiction 15 (J15) - CGS Administrators"
    },
    "medicaid": {
      "program_name": "KanCare",
      "url": "https://portal.kmap-state-ks.us"
    },
    "timely_filing": "12 months from DOS",
    "balance_billing": "Follows No Surprises Act (federal)"
  }
}

What L1 resolves

Field	Description	Used by
gpci	Geographic Practice Cost Index — adjusts Work, PE, and MP RVUs for local costs	L6 payment calculation
government_alignment	MAC jurisdiction, contractor, and DME MAC assignments	Claim submission routing
medicaid	State Medicaid program name and portal URL	L4 when payer is Medicaid
timely_filing	Deadline for submitting claims to the state’s payers	Billing teams
balance_billing	Whether balance billing is permitted	Patient billing

GPCI values explained

The Geographic Practice Cost Index adjusts Medicare’s national RVU values for local cost differences:

GPCI Component	Measures	Floor
Work GPCI (pw_gpci)	Physician labor costs relative to national average	1.000 (cannot go below)
PE GPCI (pe_gpci)	Practice expense — rent, staff wages, equipment	None
MP GPCI (mp_gpci)	Malpractice insurance premiums	None

A GPCI of 1.0 means equal to the national average. Kansas has a Work GPCI floor of 1.000, a PE GPCI of 0.904 (9.6% below average), and a very low MP GPCI of 0.504 (malpractice is cheap in Kansas).

GPCI values are updated annually by CMS from the Physician Fee Schedule Relative Value Files. L6 uses these values automatically when calculating payment.

MAC jurisdictions

The Medicare Administrative Contractor (MAC) determines where claims are submitted and which LCD/NCD policies apply:

MAC type	Purpose
A/B MAC	Processes Part A (institutional) and Part B (professional) claims
DME MAC	Processes Durable Medical Equipment claims
HH MAC	Processes Home Health claims

Knowing your MAC matters because Local Coverage Determinations (LCDs) vary by jurisdiction. A service covered under one MAC may have different documentation requirements under another.

State code reference

Common state codes used in CCNs:

Code	State	Code	State	Code	State
05	CA	17	KS	33	NY
10	FL	21	MD	39	PA
14	IL	22	MA	44	TN
15	IN	23	MI	45	TX

State codes in CCNs are not the same as FIPS codes or postal abbreviations. State code 17 is Kansas (not Illinois). Always use the CCN parser to decode — don’t assume.