Medicare payment locality · Q1 2026 release

Merced, Ca CA Medicare Locality 59

MAC 01112 · Locality 59

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q1 2026 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.017

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.096

Adjusts practice-expense inputs such as staff, rent, and services

Malpractice GPCI

0.536

Adjusts the malpractice component using liability-cost data

1.000 is the national baseline. A value above 1.000 raises that component; below 1.000 lowers it. GPCIs are Medicare payment factors, not general cost-of-living or physician-compensation indexes.

Example rates in Merced, Ca Copy link

National and Merced, Ca Office (non-facility) amounts for frequently reviewed codes in the Q1 2026 release (before sequestration). Conversion factor: 2026 standard (non-QP) physician conversion factor · $33.4009.

Code	National	Merced, Ca	Difference
99214	$135.61	$140.94	+3.9%
99213	$95.19	$99.22	+4.2%
99215	$192.39	$199.54	+3.7%
66984	$462.60	$477.99	+3.3%
99204	$177.36	$183.04	+3.2%
92014	$127.26	$134.98	+6.1%
97110	$29.06	$30.47	+4.9%
88305	$70.14	$74.58	+6.3%
97530	$35.07	$37.09	+5.8%
99203	$117.57	$121.64	+3.5%

Need a specific code or the facility amount? Use the rate calculator and choose this locality. Or start with your field's usual procedure mix on the specialty fee schedules.

ZIP codes in this locality Copy link

Merced, Ca covers 23 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q1 2026). 3 of them span more than one locality and need ZIP+4 for an exact match.

93620 93635 93661 93665 95301 95303 95312 95315 95317 95322 95324 95333 95334 95340 95341 95342 95343 95344 95348 95365 95369 95374 95388

Not sure which locality your ZIP is in? Look it up by ZIP code.

Common questions Copy link

Why do Medicare rates in Merced, Ca differ from the national amount?

For nationally priced Physician Fee Schedule services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs by this locality's three GPCIs before applying the conversion factor. Local costs for physician work, running an office, and liability insurance therefore move the final amount up or down. Merced, Ca currently has mixed GPCI components, so the net payment effect varies by code for the Q1 2026 release.

How do I know if my address is in this locality?

Medicare payment localities are geographic fee-schedule areas, commonly defined with county boundaries. CMS uses the ZIP code where the service was performed to assign a claim to its contractor and locality. Look up your ZIP to find your locality. About 3 ZIP codes in Merced, Ca span more than one locality and need the ZIP+4 to resolve exactly.

Do commercial insurers or Medicare Advantage plans use this locality?

Original Medicare uses these PFS localities directly. Commercial and Medicare Advantage plans are not required to use the same locality structure. A contract may pay a percentage of Medicare, but its own wording decides which Medicare release, percentage, geography, and adjustments apply.

Does my locality affect what I owe as a patient?

For a covered service, a higher allowed amount in your locality usually means a higher 20% coinsurance. The effect depends on the code, the beneficiary's deductible, supplemental coverage, and other claim circumstances.

Why did my Medicare payment change even though I didn't change what I billed?

CMS publishes updated PFS files during the year. A code's amount can change because of conversion-factor, RVU, policy, or correction updates. GPCIs are usually set once a year in the fee schedule rule, though later files can correct them. See what changed each release.

Source & method Copy link

We compute GPCIs and rates from the CMS Medicare Physician Fee Schedule Q1 2026 release (effective January 2026). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q1 2026 release. Example amounts use the standard (non-QP) physician conversion factor ($33.4009) and apply this locality's GPCIs to nationally priced Office (non-facility) RVUs, before the ~2% sequestration cut. Past releases are never edited, so a rate for an earlier quarter always matches what CMS published for it.

Geographic practice cost indices (Q1 2026) · rvu26a-updated-12-29-2025.zip (GPCI2026.csv row 15)

ZIP code to carrier locality crosswalk (Q1 2026) · zip-code-carrier-locality-file-revised-11-18-2025.zip (ZIP5_JAN2026.txt)

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