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Medicare Physician Fee Schedule Effective Locality 01112-09 CMS RVU26D Updated

HCPCS G0402 Medicare rate in San Jose, CA

Initial preventive exam in ZIPs including 95113, 94086, and 95050

G0402 Q4 2026
Locality-adjusted allowed amount
$217.13
in a doctor’s own office or clinic

Facility $129.96

San Jose, CA flag San Jose, CA (Locality 01112-09)

24.3% above the national baseline ($174.69)

CMS evidence · Q4 2026 release

Participating provider, no modifiers, whole service, before sequestration. Change these

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The Medicare allowed amount is $217.13 in the Office (non-facility) setting and $129.96 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.

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

San Jose, CA is in CMS payment locality San Jose-Sunnyvale-Santa Clara (Santa Clara County). The same amount applies across the whole locality, including Sunnyvale and Santa Clara.

CMS splits this metro across more than one payment locality

The amount above covers only the counties in San Jose-Sunnyvale-Santa Clara (Santa Clara County). CMS prices another part of the same metro area separately, with its own GPCIs and its own amount. Check the service-location ZIP before applying this figure.

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

ZIP codes in this payment locality (116)

The CMS ZIP-to-locality crosswalk maps 116 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.

94022 94023 94024 94035 94039 94040 94041 94042 94043 94085 94086 94087 94088 94089 94090 94301 94302 94303 94304 94305 94306 94309 94310 95002 95008 95009 95011 95013 95014 95015 95020 95021 95026 95030 95031 95032 95033 95035 95036 95037 95038 95042 95044 95046 95050 95051 95052 95053 95054 95055 95056 95070 95071 95101 95102 95103 95106 95108 95109 95110 95111 95112 95113 95114 95115 95116 95117 95118 95119 95120 95121 95122 95123 95124 95125 95126 95127 95128 95129 95130 95131 95132 95133 95134 95135 95136 95137 95138 95139 95140 95141 95142 95148 95150 95151 95152 95153 95154 95155 95156

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

Which ZIP codes does the San Jose, CA rate for G0402 cover?

The CMS ZIP-to-locality crosswalk maps 116 ZIP codes to this payment locality, and G0402 has the same amount in every one of them. Examples include 94022, 94023, 94024, 94035, 94039, 94040. Of these, 2 span more than one payment locality and need ZIP+4 for an exact match.

Which cities does the San Jose, CA rate for G0402 cover?

This payment locality also covers Sunnyvale and Santa Clara. G0402 has the same amount everywhere in it—the label names the largest metro, not a city-specific amount.

How the San Jose, CA amount is calculated Copy link

How locality affects the amount Copy link

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

San Jose, CA's $217.13 compares with the $174.69 national PFS baseline (GPCI 1.000). Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put San Jose, CA 24.3% above the national baseline.

San Jose, CA ranks #3 of 109 Medicare payment localities for G0402, where #1 has the highest allowed amount. Within California it's #2 of 29: $35.71 (19.7%) higher than Rest of California ($181.42).

Work GPCI
1.110
+$9.55 vs. national
Practice expense GPCI
1.442
+$36.32 vs. national
Malpractice GPCI
0.397
−$3.43 vs. national
2026 conversion factor
$33.4009

Each figure is that GPCI's share of the +$42.44 gap from the national baseline: its RVUs for G0402 × (GPCI − 1.000) × the conversion factor. Practice expense accounts for the most, +$36.32.

CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows

Show the full calculation and CMS rows

For the office (non-facility) amount, each of G0402's RVU components is multiplied by its San Jose, CA GPCI; the products are summed and multiplied by the conversion factor.

Code
G0402
DOS
Not selected; uses this release’s rates
Locality
San Jose-Sunnyvale-Santa Clara (Santa Clara County) (01112-09)
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 Jose, CA allowed amount for G0402
Component RVU × GPCI = Adjusted
Work 2.60 × 1.110 2.8860
Practice expense · Office (non-facility) 2.46 × 1.442 3.5473
Malpractice 0.17 × 0.397 0.0675
Sum of adjusted RVUs 6.5008
× 33.4009 conversion factor = formula amount $217.13

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

  1. Locality-adjusted allowed amount $217.13

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • G0402’s RVUs, PFS status and conversion factor

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

    PPRRVU2026_Oct_nonQPP.csv row 15,231 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    G0402
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    2.60
    G Non-facility PE RVU
    2.46
    K MP RVU
    0.17
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 15,229–15,233 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

  • Locality 01112-09’s GPCIs

    Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2

    GPCI2026.csv row 28 in rvu26d-updated-08-26-2026.zip

    A MAC
    01112
    C Locality number
    09
    E Work GPCI
    1.110
    F PE GPCI
    1.442
    G MP GPCI
    0.397
    In the CMS file

    Loading rows 26–30 of GPCI2026.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

Why is the G0402 rate in San Jose, 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 1.110, practice expense 1.442, malpractice 0.397—scale each RVU component before the conversion factor is applied, which is why the San Jose, CA amount is higher than the $174.69 baseline.

G0402 in San Jose, CA since Q4 2025 Copy link

Office (non-facility) · Participating · Whole service

The allowed amount went from $197.27 in Q4 2025 to $217.13 in Q4 2026, +$19.86 (+10.1%). The national baseline moved +8.7% over the same period.

What changed G0402's allowed amount in San Jose, CA between Q4 2025 and Q4 2026
What moved Effect
Conversion factor National: the dollar multiplier CMS sets each year. +$6.43
G0402's RVUs National: CMS revalued the code itself. +$12.12
San Jose, CA's GPCIs Local: this payment locality's cost indices. +$1.31
Total change +$19.86

A derived breakdown of the two releases' formula inputs, applied in order: the conversion factor on Q4 2025's RVUs and GPCIs, then G0402's new RVUs, then this locality's new GPCIs. A different order moves a few cents between rows; the total is exact.

Which amount applies to your claim? Copy link

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for G0402 in San Jose, CA is $129.96, versus $217.13 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 G0402 in San Jose, CA?

$129.96 in a facility, versus $217.13 in the Office (non-facility) setting—a $87.17 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.

Who pays what Copy link

Medicare pays part of the San Jose, CA allowed amount and the patient pays the rest. A provider who doesn’t participate in Medicare is allowed less, and can bill the patient up to a ceiling.

Computed from the Q4 2026 CMS release

Allowed amount

The fee-schedule amount for G0402 in the Office (non-facility) setting in San Jose, CA. A participating provider accepts it as payment in full, and every figure below starts from it.

$217.13
Medicare's share

80% of the allowed amount, once the annual Part B deductible is met.

$173.70
Sequestration

The 2% cut to Medicare’s share. It never reduces the allowed amount or the patient’s coinsurance.

-$3.47
What Medicare pays

Medicare’s share after sequestration.

$170.23
Patient coinsurance

The remaining 20%. Medigap or Medicaid often covers it.

$43.43
Non-participating amount

What a provider who doesn’t participate in Medicare is allowed on an assigned claim: 95% of the allowed amount.

$206.27
Limiting charge

The most a non-participating provider can bill the patient on an unassigned claim: 115% of the non-participating amount.

$237.21
What is the non-participating amount and limiting charge for G0402 in San Jose, CA?

A non-participating provider is paid $206.27—95% of the $217.13 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $237.21, which is 115% of the non-participating amount.

How much of the San Jose, CA G0402 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($173.70) once the annual Part B deductible is met, and the beneficiary owes 20% ($43.43). Sequestration reduces Medicare's share by about 2% ($3.47), leaving $170.23. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Who’s billing it in San Jose, CA Copy link

The allowed amount depends on who bills the service: NPs and PAs get 85% of the fee schedule amount, social workers and counselors 75%. These are San Jose, CA’s Q4 2026 amounts.

Allowed amount for G0402 by rendering provider, San Jose, CA
Billed by Office (non-facility) Facility
Physician (MD/DO) 100% The full fee schedule amount. Open in calculator $217.13 $129.96
NP, PA or CNS 85% Paid 85% of the fee schedule amount. Always takes assignment, so no limiting charge applies. Source: 42 CFR 414.52(d) · 42 CFR 414.56(c) · Pub. 100-04 ch. 12 §110, §120.A · Pub. 100-04 ch. 1 §30.3.1 Open in calculator $184.56 $110.47
NP or PA visit billed under the physician (incident-to) 100% Paid as if the physician did it, but only in the office and only when every incident-to requirement, including supervision, is met. Source: Pub. 100-02 ch. 15 §60 Open in calculator $217.13 Not available

A provider type is listed when it billed at least 1% of G0402’s Medicare services in CMS’s CY2024 Physician & Other Practitioners data. Each percentage applies before the 80/20 split and sequestration.

Contract rates and comparisons Copy link

Contracted rate: % of Medicare in San Jose, 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—$217.13 in the office (non-facility) setting—not the $174.69 national baseline.

Opens the calculator set to San Jose, 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.

G0402 in nearby payment localities Copy link

Payment localities in the same region as San Jose, CA, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for G0402. Neighboring localities often differ.

Payment locality Allowed · vs. this page

Percentages are against San Jose, CA. Every payment locality nationwide is on the HCPCS G0402 rate map.

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 01112-09'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 15,231)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 28)
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 G0402 in San Jose, CA against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.

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