Medicare payment locality · Q3 2026 release

San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) CA Medicare Locality 05

MAC 01112 · Locality 05

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

1.095

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.410

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

Malpractice GPCI

0.425

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 Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) Copy link

National and San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) 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 Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County)	Difference
99214	$135.61	$166.40	+22.7%
99213	$95.19	$117.58	+23.5%
99215	$192.39	$234.90	+22.1%
66984	$462.60	$559.07	+20.9%
99204	$177.36	$214.82	+21.1%
92014	$127.26	$163.18	+28.2%
97110	$29.06	$35.91	+23.6%
88305	$70.14	$90.56	+29.1%
97530	$35.07	$44.49	+26.9%
99203	$117.57	$143.68	+22.2%

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 Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) covers 254 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.

94002 94003 94005 94010 94011 94012 94013 94014 94015 94016 94017 94018 94019 94020 94021 94025 94026 94027 94028 94029 94030 94031 94037 94038 94044 94045 94059 94060 94061 94062 94063 94064 94065 94066 94067 94070 94071 94074 94080 94083 94096 94098 94099 94101 94102 94103 94104 94105 94106 94107 94108 94109 94110 94111 94112 94114 94115 94116 94117 94118 94119 94120 94121 94122 94123 94124 94125 94126 94127 94128 94129 94130 94131 94132 94133 94134 94135 94136 94137 94138 94139 94140 94141 94142 94143 94144 94145 94146 94147 94150 94151 94152 94153 94154 94155 94156 94157 94158 94159 94160 94161 94162 94163 94164 94165 94166 94167 94168 94169 94170 94171 94172 94175 94177 94188 94199 94307 94308 94401 94402 94403 94404 94405 94406 94407 94408 94409 94497 94501 94502 94505 94506 94507 94509 94511 94513 94514 94516 94517 94518 94519 94520 94521 94522 94523 94524 94525 94526 94527 94528 94529 94530 94531 94536 94537 94538 94539 94540 94541 94542 94543 94544 94545 94546 94547 94548 94549 94550 94551 94552 94553 94555 94556 94557 94560 94561 94563 94564 94565 94566 94568 94569 94570 94572 94575 94577 94578 94579 94580 94582 94583 94586 94587 94588 94595 94596 94597 94598 94601 94602 94603 94604 94605 94606 94607 94608 94609 94610 94611 94612 94613 94614 94615 94617 94618 94619 94620 94621 94622 94623 94624 94625 94626 94627 94643 94649 94659 94660 94661 94662 94666 94701 94702 94703 94704 94705 94706 94707 94708 94709 94710 94712 94720 94801 94802 94803 94804 94805 94806 94807 94808 94820 94850 94875

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

Common questions Copy link

Why do Medicare rates in San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) 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 Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) 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 Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) 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 24)

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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