Medicare payment locality · Q3 2026 release

Sacramento-Roseville-Folsom CA Medicare Locality 63

MAC 01112 · Locality 63

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q3 2026 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.036

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.163

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 Sacramento-Roseville-Folsom Copy link

National and Sacramento-Roseville-Folsom Office (non-facility) amounts for frequently reviewed codes in the Q3 2026 release (before sequestration). Conversion factor: 2026 standard (non-QP) physician conversion factor · $33.4009.

Code	National	Sacramento-Roseville-Folsom	Difference
99214	$135.61	$146.64	+8.1%
99213	$95.19	$103.31	+8.5%
99215	$192.39	$207.47	+7.8%
66984	$462.60	$496.28	+7.3%
99204	$177.36	$190.21	+7.2%
92014	$127.26	$141.14	+10.9%
97110	$29.06	$31.68	+9.0%
88305	$70.14	$78.06	+11.3%
97530	$35.07	$38.71	+10.4%
99203	$117.57	$126.60	+7.7%

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

Sacramento-Roseville-Folsom covers 219 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q3 2026). 9 of them span more than one locality and need ZIP+4 for an exact match.

94203 94204 94205 94206 94207 94208 94209 94211 94229 94230 94232 94234 94235 94236 94237 94239 94240 94243 94244 94245 94246 94247 94248 94249 94250 94252 94253 94254 94256 94257 94258 94259 94261 94262 94263 94267 94268 94269 94271 94273 94274 94277 94278 94279 94280 94282 94283 94284 94285 94286 94287 94288 94289 94290 94291 94293 94294 94295 94296 94297 94298 94299 95602 95603 95604 95605 95606 95607 95608 95609 95610 95611 95612 95613 95614 95615 95616 95617 95618 95619 95621 95623 95624 95626 95627 95628 95630 95631 95632 95633 95634 95635 95636 95637 95638 95639 95641 95645 95648 95650 95651 95652 95653 95655 95656 95658 95660 95661 95662 95663 95664 95667 95670 95671 95672 95673 95677 95678 95679 95680 95681 95682 95683 95684 95690 95691 95693 95694 95695 95697 95698 95701 95703 95709 95713 95714 95715 95717 95720 95721 95722 95726 95735 95736 95741 95742 95743 95746 95747 95757 95758 95759 95762 95763 95765 95776 95798 95799 95811 95812 95813 95814 95815 95816 95817 95818 95819 95820 95821 95822 95823 95824 95825 95826 95827 95828 95829 95830 95831 95832 95833 95834 95835 95836 95837 95838 95840 95841 95842 95843 95851 95852 95853 95857 95860 95864 95865 95866 95867 95873 95887 95894 95899 95937 96140 96141 96142 96143 96145 96146 96148 96150 96151 96152 96154 96155 96156 96157 96158

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

Common questions Copy link

Why do Medicare rates in Sacramento-Roseville-Folsom 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. Sacramento-Roseville-Folsom currently has mixed GPCI components, so the net payment effect varies by code for the Q3 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 9 ZIP codes in Sacramento-Roseville-Folsom 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 Q3 2026 release (effective July 2026). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 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 (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 21)

ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

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