Medicare payment locality · Q4 2026 release

Metropolitan Philadelphia PA Medicare Locality 01

MAC 12502 · 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 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

1.018

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.041

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

Malpractice GPCI

1.193

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 Metropolitan Philadelphia Copy link

National and Metropolitan Philadelphia 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	Metropolitan Philadelphia	Difference
99214	$135.61	$140.40	+3.5%
99213	$95.19	$98.55	+3.5%
99215	$192.39	$199.19	+3.5%
66984	$462.60	$478.80	+3.5%
99204	$177.36	$183.85	+3.7%
92014	$127.26	$131.59	+3.4%
97110	$29.06	$29.96	+3.1%
88305	$70.14	$72.56	+3.5%
97530	$35.07	$36.22	+3.3%
99203	$117.57	$121.97	+3.7%

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

Metropolitan Philadelphia covers 363 ZIP codes across PA, per the CMS ZIP-to-locality crosswalk (Q4 2026). 11 of them span more than one locality and need ZIP+4 for an exact match.

18039 18041 18054 18070 18073 18074 18076 18077 18081 18084 18901 18902 18910 18911 18912 18913 18914 18915 18916 18917 18918 18920 18921 18922 18923 18924 18925 18926 18927 18928 18929 18930 18931 18932 18933 18934 18935 18936 18938 18940 18942 18943 18944 18946 18947 18949 18950 18951 18953 18954 18955 18956 18957 18958 18960 18962 18963 18964 18966 18968 18969 18970 18971 18972 18974 18976 18977 18979 18980 18981 18991 19001 19002 19003 19004 19006 19007 19008 19009 19010 19012 19013 19014 19015 19016 19017 19018 19019 19020 19021 19022 19023 19025 19026 19027 19028 19029 19030 19031 19032 19033 19034 19035 19036 19037 19038 19039 19040 19041 19043 19044 19046 19047 19048 19049 19050 19052 19053 19054 19055 19056 19057 19058 19059 19060 19061 19063 19064 19065 19066 19067 19070 19072 19073 19074 19075 19076 19078 19079 19080 19081 19082 19083 19085 19086 19087 19088 19089 19090 19091 19092 19093 19094 19095 19096 19098 19099 19101 19102 19103 19104 19105 19106 19107 19108 19109 19110 19111 19112 19113 19114 19115 19116 19118 19119 19120 19121 19122 19123 19124 19125 19126 19127 19128 19129 19130 19131 19132 19133 19134 19135 19136 19137 19138 19139 19140 19141 19142 19143 19144 19145 19146 19147 19148 19149 19150 19151 19152 19153 19154 19155 19160 19161 19162 19170 19171 19172 19173 19175 19176 19177 19178 19179 19181 19182 19183 19184 19185 19187 19188 19190 19191 19192 19193 19194 19195 19196 19197 19244 19255 19301 19310 19311 19312 19316 19317 19318 19319 19320 19330 19331 19333 19335 19339 19340 19341 19342 19343 19344 19345 19346 19347 19348 19350 19351 19352 19353 19354 19355 19357 19358 19360 19362 19363 19365 19366 19367 19369 19370 19371 19372 19373 19374 19375 19376 19380 19381 19382 19383 19388 19390 19395 19397 19398 19399 19401 19403 19404 19405 19406 19407 19408 19409 19415 19420 19421 19422 19423 19424 19425 19426 19428 19429 19430 19432 19435 19436 19437 19438 19440 19441 19442 19443 19444 19446 19450 19451 19452 19453 19454 19455 19456 19457 19460 19462 19464 19465 19468 19470 19472 19473 19474 19475 19477 19478 19480 19481 19482 19483 19484 19485 19486 19487 19488 19489 19490 19492 19493 19494 19495 19496 19520 19525

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

Common questions Copy link

Why do Medicare rates in Metropolitan Philadelphia 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. Metropolitan Philadelphia 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 11 ZIP codes in Metropolitan Philadelphia 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, Q4 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 89)

ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

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