Medicare payment locality · Q3 2026 release

San Jose-Sunnyvale-Santa Clara (Santa Clara County) CA Medicare Locality 09

MAC 01112 · Locality 09

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

1.110

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.442

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

Malpractice GPCI

0.397

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 Jose-Sunnyvale-Santa Clara (Santa Clara County) Copy link

National and San Jose-Sunnyvale-Santa Clara (Santa Clara 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 Jose-Sunnyvale-Santa Clara (Santa Clara County)	Difference
99214	$135.61	$169.37	+24.9%
99213	$95.19	$119.71	+25.8%
99215	$192.39	$239.05	+24.3%
66984	$462.60	$568.72	+22.9%
99204	$177.36	$218.54	+23.2%
92014	$127.26	$166.36	+30.7%
97110	$29.06	$36.56	+25.8%
88305	$70.14	$92.35	+31.7%
97530	$35.07	$45.34	+29.3%
99203	$117.57	$146.21	+24.4%

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 Jose-Sunnyvale-Santa Clara (Santa Clara County) covers 116 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.

94022 94023 94024 94035 94039 94040 94041 94042 94043 94085 94086 94087 94088 94089 94090 94301 94302 94303 94304 94305 94306 94309 94310 95002 95008 95009 95011 95013 95014 95015 95020 95021 95026 95030 95031 95032 95033 95035 95036 95037 95038 95042 95044 95046 95050 95051 95052 95053 95054 95055 95056 95070 95071 95101 95102 95103 95106 95108 95109 95110 95111 95112 95113 95114 95115 95116 95117 95118 95119 95120 95121 95122 95123 95124 95125 95126 95127 95128 95129 95130 95131 95132 95133 95134 95135 95136 95137 95138 95139 95140 95141 95142 95148 95150 95151 95152 95153 95154 95155 95156 95157 95158 95159 95160 95161 95164 95170 95171 95172 95173 95190 95191 95192 95193 95194 95196

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

Common questions Copy link

Why do Medicare rates in San Jose-Sunnyvale-Santa Clara (Santa Clara 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 Jose-Sunnyvale-Santa Clara (Santa Clara 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 Jose-Sunnyvale-Santa Clara (Santa Clara 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 28)

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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