Medicare payment locality · Q4 2026 release

Queens NY Medicare Locality 04

MAC 13292 · Locality 04

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 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

1.064

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.182

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

Malpractice GPCI

1.442

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 Queens Copy link

National and Queens Office (non-facility) amounts for frequently reviewed codes in the Q4 2026 release (before sequestration). Conversion factor: 2026 standard (non-QP) physician conversion factor · $33.4009.

Code	National	Queens	Difference
99214	$135.61	$153.94	+13.5%
99213	$95.19	$108.18	+13.6%
99215	$192.39	$218.19	+13.4%
66984	$462.60	$523.23	+13.1%
99204	$177.36	$201.47	+13.6%
92014	$127.26	$145.17	+14.1%
97110	$29.06	$32.66	+12.4%
88305	$70.14	$80.20	+14.3%
97530	$35.07	$39.81	+13.5%
99203	$117.57	$134.05	+14.0%

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

Queens covers 84 ZIP codes across NY, per the CMS ZIP-to-locality crosswalk (Q3 2026). 1 of them span more than one locality and need ZIP+4 for an exact match.

We don't have the Q4 2026 ZIP-to-locality crosswalk file yet; figures are from the Q3 2026 release and may not reflect Q4 2026 changes.

11004 11005 11101 11102 11103 11104 11105 11106 11109 11120 11351 11352 11353 11354 11355 11356 11357 11358 11359 11360 11361 11362 11363 11364 11365 11366 11367 11368 11369 11370 11371 11372 11373 11374 11375 11377 11378 11379 11380 11381 11385 11386 11388 11390 11405 11411 11412 11413 11414 11415 11416 11417 11418 11419 11420 11421 11422 11423 11424 11425 11426 11427 11428 11429 11430 11431 11432 11433 11434 11435 11436 11437 11439 11451 11484 11499 11690 11691 11692 11693 11694 11695 11696 11697

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

Common questions Copy link

Why do Medicare rates in Queens 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. Queens 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 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 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 1 ZIP codes in Queens 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 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 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 (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 81)

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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