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Medicare Physician Fee Schedule · Q4 2026 release

HCPCS G0121 in San Diego, CA

Colon ca scrn not hi rsk ind in ZIPs including 92101, 92037, and 92008

G0121 Q4 2026 · San Diego, CA flag01182-72
Locality-adjusted allowed amount
$425.80
in a doctor’s own office or clinic

112.5% of the $378.43 national baseline

( Work3.18 × 1.030 + Practice exp.7.73 × 1.196 + Malpractice0.42 × 0.542 ) × Conv. factor$33.4009 = $425.80

The Medicare allowed amount is $425.80 in the Office (non-facility) setting and $170.53 in a facility, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.

Q4 2026 · Locality 01182-72 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is San Diego, CA in? Copy link

San Diego, CA is in CMS payment locality San Diego-Chula Vista-Carlsbad. The same amount applies across the whole locality, including Chula Vista and Carlsbad.

Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.

ZIP codes in this payment locality (190)

The CMS ZIP-to-locality crosswalk maps 190 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 2 span more than one locality and need ZIP+4 for an exact match.

91901 91902 91903 91905 91906 91908 91909 91910 91911 91912 91913 91914 91915 91916 91917 91921 91931 91932 91933 91934 91935 91941 91942 91943 91944 91945 91946 91947 91948 91950 91951 91962 91963 91976 91977 91978 91979 91980 91987 91990 92003 92004 92007 92008 92009 92010 92011 92013 92014 92018 92019 92020 92021 92022 92023 92024 92025 92026 92027 92028 92029 92030 92033 92036 92037 92038 92039 92040 92046 92049 92051 92052 92054 92055 92056 92057 92058 92059 92060 92061 92064 92065 92066 92067 92068 92069 92070 92071 92072 92074 92075 92078 92079 92081 92082 92083 92084 92085 92086 92088

90 more ZIP codes map to this locality. The San Diego, CA locality page lists the full set.

Which ZIP codes does the San Diego, CA rate for G0121 cover?

The CMS ZIP-to-locality crosswalk maps 190 ZIP codes to this payment locality, and G0121 has the same amount in every one of them. Examples include 91901, 91902, 91903, 91905, 91906, 91908. Of these, 2 span more than one payment locality and need ZIP+4 for an exact match.

Which cities does the San Diego, CA rate for G0121 cover?

This payment locality also covers Chula Vista and Carlsbad. G0121 has the same amount everywhere in it—the label names the largest metro, not a city-specific amount.

How locality affects the amount Copy link

Office (non-facility) · Q4 2026 · Participating · Whole service

San Diego, CA (this locality)
$425.80
National PFS baseline (GPCI 1.000)
$378.43

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put San Diego, CA 12.5% above the national baseline.

Work GPCI
1.030
Practice expense GPCI
1.196
Malpractice GPCI
0.542
2026 conversion factor
$33.4009
Why is the G0121 rate in San Diego, CA different from the national amount?

The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices—work 1.030, practice expense 1.196, malpractice 0.542—scale each RVU component before the conversion factor is applied, which is why the San Diego, CA amount is higher than the $378.43 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of G0121's RVU components is multiplied by its San Diego, CA GPCI; the products are summed and multiplied by the conversion factor.

Code
G0121
DOS
Not selected; uses this release’s rates
Locality
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q4 2026, revision 2
Sequestration
Shown separately from the allowed amount

Formula

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from.

RVU × GPCI components of San Diego, CA allowed amount for G0121
Component RVU × GPCI = Adjusted
Work 3.18 × 1.030 3.2754
Practice expense · Office (non-facility) 7.73 × 1.196 9.2451
Malpractice 0.42 × 0.542 0.2276
Sum of adjusted RVUs 12.7481
× 33.4009 conversion factor = formula amount $425.80

Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.

  1. Locality-adjusted allowed amount $425.80

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • Supplies the RVUs and PFS status for this code and component.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 15,093)
    hcpcs (col 1)
    G0121
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    3.18
    pe_rvu_nonfacility (col 7)
    7.73
    pe_rvu_facility (col 9)
    1.34
    mp_rvu (col 11)
    0.42

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

  • Supplies the geographic adjustment factors for this locality.

    Geographic practice cost indices (GPCI)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details GPCI2026.csv in rvu26d-updated-08-26-2026.zip (row 23)
    mac (col 1)
    01182
    locality_code (col 3)
    72
    work_gpci (col 5)
    1.03
    pe_gpci (col 6)
    1.196
    mp_gpci (col 7)
    0.542

    SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

    Original source file

  • Supplies the dollar conversion factor used in the formula.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 11)
    conversion_factor (col 26)
    33.4009

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for G0121 in San Diego, CA is $170.53, versus $425.80 in the Office (non-facility) setting. Only the practice-expense RVU changes with the setting: the facility bills its own fee for overhead, so the professional amount is lower. See which setting applies to your place of service.

What is the Facility amount for G0121 in San Diego, CA?

$170.53 in a facility, versus $425.80 in the Office (non-facility) setting—a $255.27 difference. Only the practice-expense RVU changes with the setting: in the Office (non-facility) setting the practice carries the overhead, so the professional amount is higher; in a hospital or ASC the facility bills its own fee.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in San Diego, CA. Medicare pays part of the allowed amount and the patient pays the rest; the rows below show each figure. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for G0121 in San Diego, CA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $425.80
Non-participating allowed amount 95% of the participating amount. $404.51
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $465.19
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $340.64
Patient coinsurance The remaining 20%. $85.16
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $6.81
Net Medicare payment Medicare's share after the sequestration reduction. $333.83
What is the non-participating amount and limiting charge for G0121 in San Diego, CA?

A non-participating provider is paid $404.51—95% of the $425.80 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $465.19, which is 115% of the non-participating amount.

How much of the San Diego, CA G0121 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($340.64) once the annual Part B deductible is met, and the beneficiary owes 20% ($85.16). Sequestration reduces Medicare's share by about 2% ($6.81), leaving $333.83. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in San Diego, CA Copy link

Commercial contracts are often written as a percentage of the Medicare fee schedule. The part that gets misread is which Medicare amount: a contract benchmarked to the fee schedule prices off this locality's allowed amount—$425.80 in the office (non-facility) setting—not the $378.43 national baseline.

Opens the calculator set to San Diego, CA and your selected setting, where you can also compare what a payer paid against the expected amount. See how to find your contract's actual percentage.

Compare G0121 in nearby payment localities

Payment localities in the same region as San Diego, CA, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for G0121. Neighboring localities often differ.

G0121 allowed amount in payment localities near San Diego, CA
Metro Allowed amount vs. San Diego, CA
Riverside, CA $403.07 -5.3%
Los Angeles, CA $425.32 -0.1%
Ventura County, CA $423.11 -0.6%
Phoenix, AZ $368.41 -13.5%
Bakersfield, CA $399.75 -6.1%
Las Vegas, NV $376.35 -11.6%

Every payment locality nationwide is on the HCPCS G0121 rate map.

Other codes priced in San Diego, CA Copy link

Office (non-facility) allowed amounts in this same payment locality, Q4 2026.

Other curated codes and their allowed amounts in San Diego, CA
Code and service Allowed vs. national
43239 Upper Gastrointestinal Endoscopy With Tissue Sampling $482.12 +15.1%
45385 Colonoscopy With Polyp Removal $562.14 +12.4%
45380 Colonoscopy With Tissue Sampling $545.63 +13.7%
45378 Diagnostic Colonoscopy $425.62 +12.6%
43235 Screening and endoscopy $369.34 +14.5%
45384 Screening and endoscopy $609.81 +13.0%
45381 Screening and endoscopy $558.01 +13.8%
G0105 Screening and endoscopy $425.62 +12.6%
99213 Routine Follow-Up Office Visit $104.68 +10.0%
99214 Long Follow-Up Office Visit $148.48 +9.5%
66984 Cataract Surgery $501.72 +8.5%
92014 Full Eye Exam, Returning Patient $143.45 +12.7%

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q4 2026 release: this code's RVUs from the relative value file, multiplied by payment locality 01182-72's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 2026 release. Past releases are never edited, so an amount for an earlier quarter always matches what CMS published for it. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 15,093)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 23)
ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

Working a claim with an earlier date of service? The calculator prices G0121 in San Diego, CA against the release in effect on that date. Dates in the last 12 months don't need an account; older dates of service need a free account.

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