Medicare payment locality · Q4 2026 release

Northern Nj NJ Medicare Locality 01

MAC 12402 · Locality 01

This locality's GPCIs are all at or above the national baseline, so normally RVU-priced services tend to price above the national amount for the Q4 2026 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.063

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.160

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

Malpractice GPCI

1.068

Adjusts the malpractice component using liability-cost data

1.000 is the national baseline. Above raises that component; below lowers it. GPCIs are Medicare payment factors, not general cost-of-living or physician-compensation indexes.

Example rates in Northern Nj Copy link

National vs. Northern Nj office (non-facility) amounts for frequently reviewed codes, Q4 2026 (before sequestration). Conversion factor: 2026 standard (non-QP) physician conversion factor · $33.4009.

Code	National	Northern Nj	Difference
99214	$135.61	$150.65	+11.1%
99213	$95.19	$105.93	+11.3%
99215	$192.39	$213.45	+10.9%
66984	$462.60	$511.73	+10.6%
99204	$177.36	$196.57	+10.8%
92014	$127.26	$142.90	+12.3%
97110	$29.06	$32.22	+10.9%
88305	$70.14	$78.94	+12.5%
97530	$35.07	$39.23	+11.9%
99203	$117.57	$130.71	+11.2%

Need a specific code or a facility rate? Use the rate calculator with this locality selected. Or start from your field's usual procedure mix on the specialty fee schedules.

ZIP codes in this locality Copy link

Northern Nj covers 429 ZIP codes across NJ, per the CMS ZIP-to-locality crosswalk (Q3 2026). 4 of them span more than one locality and need ZIP+4 for an exact match.

The Q4 2026 ZIP-to-locality crosswalk file is not on file here; figures are from the Q3 2026 release and may not reflect Q4 2026 revisions.

07001 07002 07003 07004 07005 07006 07007 07008 07009 07010 07011 07012 07013 07014 07015 07016 07017 07018 07019 07020 07021 07022 07023 07024 07026 07027 07028 07029 07030 07031 07032 07033 07034 07035 07036 07039 07040 07041 07042 07043 07044 07045 07046 07047 07050 07051 07052 07054 07055 07057 07058 07059 07060 07061 07062 07063 07064 07065 07066 07067 07068 07069 07070 07071 07072 07073 07074 07075 07076 07077 07078 07079 07080 07081 07082 07083 07086 07087 07088 07090 07091 07092 07093 07094 07095 07096 07097 07099 07101 07102 07103 07104 07105 07106 07107 07108 07109 07110 07111 07112 07114 07175 07182 07184 07188 07189 07191 07192 07193 07194 07195 07197 07198 07199 07201 07202 07203 07204 07205 07206 07207 07208 07215 07216 07302 07303 07304 07305 07306 07307 07308 07309 07310 07311 07390 07395 07399 07401 07403 07405 07407 07410 07416 07417 07418 07419 07420 07421 07422 07423 07424 07428 07430 07432 07435 07436 07438 07439 07440 07442 07444 07446 07450 07451 07452 07456 07457 07458 07460 07461 07462 07463 07465 07470 07474 07477 07480 07481 07495 07498 07501 07502 07503 07504 07505 07506 07507 07508 07509 07510 07511 07512 07513 07514 07522 07524 07530 07533 07538 07543 07544 07601 07602 07603 07604 07605 07606 07607 07608 07620 07621 07624 07626 07627 07628 07630 07631 07632 07640 07641 07642 07643 07644 07645 07646 07647 07648 07649 07650 07652 07653 07656 07657 07660 07661 07662 07663 07666 07670 07675 07676 07677 07688 07699 07801 07802 07803 07806 07820 07821 07822 07823 07825 07826 07827 07828 07829 07830 07831 07832 07833 07834 07836 07837 07838 07839 07840 07842 07843 07844 07845 07846 07847 07848 07849 07850 07851 07852 07853 07855 07856 07857 07860 07863 07865 07866 07869 07870 07871 07874 07875 07876 07877 07878 07879 07880 07881 07882 07885 07890 07901 07902 07920 07921 07922 07924 07926 07927 07928 07930 07931 07932 07933 07934 07935 07936 07938 07939 07940 07945 07946 07950 07960 07961 07962 07963 07970 07974 07976 07977 07978 07979 07980 07981 07983 07999 08502 08504 08512 08528 08530 08536 08551 08553 08556 08557 08558 08559 08570 08801 08802 08803 08804 08805 08807 08808 08809 08810 08812 08816 08817 08818 08820 08821 08822 08823 08824 08825 08826 08827 08828 08829 08830 08831 08832 08833 08834 08835 08836 08837 08840 08844 08846 08848 08850 08852 08853 08854 08855 08857 08858 08859 08861 08862 08863 08865 08867 08868 08869 08870 08871 08872 08873 08875 08876 08877 08878 08879 08880 08882 08884 08885 08886 08887 08888 08889 08890 08896 08899 08901 08902 08903 08904 08905 08906 08922 08933 08988 08989

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

Common questions Copy link

Why do Medicare rates in Northern Nj 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 professional labor, office-input, and liability costs therefore move the final amount up or down. Northern Nj currently has all three GPCI components at or above the national baseline, so normally RVU-priced services tend to price above the national amount for the Q4 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 service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. About 4 ZIP codes in Northern Nj 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 benchmark payment to Medicare, but its language controls the Medicare release, percentage, geographic basis, and other adjustments.

Does my locality affect what I owe as a patient?

For a particular covered service, a higher locality-adjusted allowed amount generally produces a higher percentage-based coinsurance amount. 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. GPCI policy values are generally established through annual rulemaking, although later files can contain corrections. See what changed each release.

Source & method Copy link

GPCIs and rates computed from the CMS Medicare Physician Fee Schedule Q4 2026 release (effective October 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 non-facility RVUs, before the ~2% sequestration cut. Releases are immutable: a rate retrieved for a past quarter always reflects that PFS release.

Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 75)

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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