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Medicare payment locality · Q3 2026 release

San Diego-Chula Vista-Carlsbad flag

San Diego–Chula Vista–Carlsbad

California MAC 01182 · Locality 72

Work GPCI
1.030
Practice expense GPCI
1.196
Malpractice GPCI
0.542

The GPCIs fall on both sides of the national baseline of 1.000, so whether a code pays more or less here depends on its mix of work, practice-expense and malpractice RVUs.

Effective CMS RVU26C Updated

Price a code in San Diego–Chula Vista–Carlsbad Copy link

The locality-adjusted amount for the Q3 2026 release, with the facility and office settings and the full calculation.

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, outlined with a dashed border below, span more than one locality: CMS places those by ZIP+4, so this locality holds for only part of each.

  • 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 (split ZIP)
  • 92007
  • 92008
  • 92009
  • 92010
  • 92011
  • 92013
  • 92014
  • 92018
  • 92019
  • 92020
  • 92021
  • 92022
  • 92023
  • 92024
  • 92025
  • 92026
  • 92027
  • 92028 (split ZIP)
Show all 190 ZIP codes
  • 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

Have a service address? Look up its ZIP and date of service to confirm the locality.

GPCI history Copy link

This locality's GPCIs in each release on file, newest first. Releases with unchanged GPCIs share a row.

Release Work PE MP
January 2026 to October 2026 (this page) 1.030 1.196 0.542
January 2024 to October 2025 1.028 1.191 0.572
January 2023 to October 2023 1.032 1.176 0.596
January 2022 to October 2022 1.037 1.160 0.620
January 2021 to October 2021 1.035 1.145 0.616
January 2020 to October 2020 1.032 1.130 0.607
January 2019 to October 2019 1.023 1.116 0.570
January 2018 to October 2018 1.022 1.102 0.567
January 2017 to October 2017 1.024 1.088 0.610

Example rates in San Diego–Chula Vista–Carlsbad Copy link

National and local 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 Local 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 the facility amount, a modifier, or a date of service? Use the rate calculator, already set to this locality. Or start with your field's usual procedure mix on the specialty fee schedules.

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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