Medicare payment locality · Q3 2026 release

Austin TX Medicare Locality 31

MAC 04412 · Locality 31

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

1.002

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.058

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

Malpractice GPCI

0.886

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 Austin Copy link

National and Austin 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	Austin	Difference
99214	$135.61	$139.08	+2.6%
99213	$95.19	$97.77	+2.7%
99215	$192.39	$197.10	+2.4%
66984	$462.60	$472.92	+2.2%
99204	$177.36	$181.40	+2.3%
92014	$127.26	$131.75	+3.5%
97110	$29.06	$29.85	+2.7%
88305	$70.14	$72.73	+3.7%
97530	$35.07	$36.22	+3.3%
99203	$117.57	$120.48	+2.5%

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

Austin covers 89 ZIP codes across TX, per the CMS ZIP-to-locality crosswalk (Q3 2026). 12 of them span more than one locality and need ZIP+4 for an exact match.

73301 73344 78617 78645 78651 78652 78653 78660 78669 78691 78701 78702 78703 78704 78705 78708 78709 78710 78711 78712 78713 78714 78715 78716 78718 78719 78720 78721 78722 78723 78724 78725 78726 78727 78728 78730 78731 78732 78733 78734 78735 78736 78738 78739 78741 78742 78744 78745 78746 78747 78748 78749 78750 78751 78752 78753 78754 78755 78756 78757 78758 78759 78760 78761 78762 78763 78764 78765 78766 78767 78768 78769 78771 78772 78773 78774 78778 78779 78780 78781 78782 78783 78785 78786 78787 78788 78789 78798 78799

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

Common questions Copy link

Why do Medicare rates in Austin 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. Austin 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 12 ZIP codes in Austin 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 96)

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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