Medicare payment locality · Q3 2021 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 2021 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.077

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.329

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

Malpractice GPCI

0.458

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 2021 release (before sequestration). Conversion factor: 2021 standard (non-QP) physician conversion factor · $34.8931.

Code	National	San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County)	Difference
99214	$131.20	$153.22	+16.8%
99213	$92.47	$108.42	+17.2%
99215	$183.19	$212.46	+16.0%
66984	$548.17	$647.78	+18.2%
99204	$169.93	$195.98	+15.3%
92014	$128.41	$156.65	+22.0%
97110	$30.36	$35.78	+17.9%
88305	$71.53	$87.86	+22.8%
97530	$39.43	$47.92	+21.5%
99203	$113.75	$132.55	+16.5%

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

San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) covers 72 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q3 2021).

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 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

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 2021 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. A few ZIPs nationally span multiple localities and need 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 2021 release (effective July 2021). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2021 release. Example amounts use the standard (non-QP) physician conversion factor ($34.8931) 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 2021) · rvu21c-updated-6302021.zip (GPCI2021.csv row 26)

ZIP code to carrier locality crosswalk (Q3 2021) · Zip-Code-to-Carrier-Locality.zip (ZIP5_JUL2021.txt)

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