Medicare payment locality · Q3 2026 release

Baltimore/Surr. Counties MD Medicare Locality 01

MAC 12302 · Locality 01

This locality's GPCIs are all at or above the national baseline, so services priced with the standard RVU formula usually come out above the national amount 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

1.016

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.073

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

Malpractice GPCI

1.237

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 Baltimore/Surr. Counties Copy link

National and Baltimore/Surr. Counties 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	Baltimore/Surr. Counties	Difference
99214	$135.61	$142.62	+5.2%
99213	$95.19	$100.16	+5.2%
99215	$192.39	$202.25	+5.1%
66984	$462.60	$485.68	+5.0%
99204	$177.36	$186.67	+5.2%
92014	$127.26	$134.06	+5.3%
97110	$29.06	$30.38	+4.5%
88305	$70.14	$73.98	+5.5%
97530	$35.07	$36.85	+5.1%
99203	$117.57	$123.98	+5.5%

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

Baltimore/Surr. Counties covers 202 ZIP codes across MD, per the CMS ZIP-to-locality crosswalk (Q3 2026). 5 of them span more than one locality and need ZIP+4 for an exact match.

20588 20701 20711 20723 20724 20733 20751 20755 20758 20759 20763 20764 20765 20776 20777 20778 20779 20794 21001 21005 21009 21010 21012 21013 21014 21015 21017 21018 21020 21022 21023 21027 21028 21029 21030 21031 21032 21034 21035 21036 21037 21040 21041 21042 21043 21044 21045 21046 21047 21048 21050 21051 21052 21053 21054 21055 21056 21057 21060 21061 21062 21065 21071 21074 21075 21076 21077 21078 21080 21082 21084 21085 21087 21088 21090 21092 21093 21094 21098 21102 21104 21105 21106 21108 21111 21113 21114 21117 21120 21122 21123 21128 21130 21131 21132 21133 21136 21139 21140 21144 21146 21150 21152 21153 21154 21155 21156 21157 21158 21160 21161 21162 21163 21200 21201 21202 21203 21204 21205 21206 21207 21208 21209 21210 21211 21212 21213 21214 21215 21216 21217 21218 21219 21220 21221 21222 21223 21224 21225 21226 21227 21228 21229 21230 21231 21233 21234 21235 21236 21237 21239 21240 21241 21244 21250 21251 21252 21260 21261 21263 21264 21265 21268 21270 21273 21274 21275 21278 21279 21280 21281 21282 21283 21284 21285 21286 21287 21288 21289 21290 21297 21298 21401 21402 21403 21404 21405 21409 21411 21412 21723 21737 21738 21757 21764 21765 21776 21784 21787 21791 21794 21797

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

Common questions Copy link

Why do Medicare rates in Baltimore/Surr. Counties 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. Baltimore/Surr. Counties currently has all three GPCIs at or above the national baseline, so services priced with the standard RVU formula usually come out above the national amount 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 5 ZIP codes in Baltimore/Surr. Counties 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 60)

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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