Medicare payment locality · Q3 2026 release

San Diego-Chula Vista-Carlsbad CA Medicare Locality 72

MAC 01182 · Locality 72

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

1.030

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.196

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

Malpractice GPCI

0.542

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 San Diego-Chula Vista-Carlsbad Copy link

National and San Diego-Chula Vista-Carlsbad 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	San Diego-Chula Vista-Carlsbad	Difference
99214	$135.61	$148.48	+9.5%
99213	$95.19	$104.68	+10.0%
99215	$192.39	$209.99	+9.1%
66984	$462.60	$501.72	+8.5%
99204	$177.36	$192.46	+8.5%
92014	$127.26	$143.45	+12.7%
97110	$29.06	$32.04	+10.3%
88305	$70.14	$79.41	+13.2%
97530	$35.07	$39.29	+12.0%
99203	$117.57	$128.25	+9.1%

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

San Diego-Chula Vista-Carlsbad covers 190 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q3 2026). 2 of them 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 92090 92091 92092 92093 92096 92101 92102 92103 92104 92105 92106 92107 92108 92109 92110 92111 92112 92113 92114 92115 92116 92117 92118 92119 92120 92121 92122 92123 92124 92126 92127 92128 92129 92130 92131 92132 92133 92134 92135 92136 92137 92138 92139 92140 92142 92143 92145 92147 92149 92150 92152 92153 92154 92155 92158 92159 92160 92161 92162 92163 92164 92165 92166 92167 92168 92169 92170 92171 92172 92173 92174 92175 92176 92177 92178 92179 92182 92184 92186 92187 92190 92191 92192 92193 92194 92195 92196 92197 92198 92199

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

Common questions Copy link

Why do Medicare rates in San Diego-Chula Vista-Carlsbad 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. San Diego-Chula Vista-Carlsbad 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 2 ZIP codes in San Diego-Chula Vista-Carlsbad 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 23)

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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