Medicare payment locality · Q3 2026 release

Dallas, Tx TX Medicare Locality 11

MAC 04412 · Locality 11

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

1.009

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

0.996

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

Malpractice GPCI

0.858

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 Dallas, Tx Copy link

National vs. Dallas, Tx office (non-facility) amounts for frequently reviewed codes, Q3 2026 (before sequestration). Conversion factor: 2026 standard (non-QP) physician conversion factor · $33.4009.

Code	National	Dallas, Tx	Difference
99214	$135.61	$135.25	-0.3%
99213	$95.19	$94.96	-0.2%
99215	$192.39	$191.87	-0.3%
66984	$462.60	$461.38	-0.3%
99204	$177.36	$176.67	-0.4%
92014	$127.26	$127.18	-0.1%
97110	$29.06	$29.09	+0.1%
88305	$70.14	$70.09	-0.1%
97530	$35.07	$35.08	0.0%
99203	$117.57	$117.06	-0.4%

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

Dallas, Tx covers 186 ZIP codes across TX, per the CMS ZIP-to-locality crosswalk (Q3 2026). 17 of them span more than one locality and need ZIP+4 for an exact match.

75001 75006 75011 75014 75015 75016 75017 75019 75030 75037 75038 75039 75040 75041 75042 75043 75044 75045 75046 75047 75048 75049 75050 75051 75052 75053 75054 75059 75060 75061 75062 75063 75064 75080 75081 75082 75083 75084 75085 75088 75089 75099 75104 75106 75115 75116 75123 75134 75137 75138 75141 75146 75149 75150 75159 75172 75180 75181 75182 75185 75187 75201 75202 75203 75204 75205 75206 75207 75208 75209 75210 75211 75212 75214 75215 75216 75217 75218 75219 75220 75221 75222 75223 75224 75225 75226 75227 75228 75229 75230 75231 75232 75233 75234 75235 75236 75237 75238 75239 75240 75241 75242 75243 75244 75245 75246 75247 75248 75249 75250 75251 75253 75254 75258 75260 75261 75262 75263 75264 75265 75266 75267 75270 75275 75277 75283 75284 75285 75286 75294 75295 75301 75303 75310 75312 75313 75315 75320 75323 75326 75334 75336 75339 75340 75342 75343 75344 75346 75350 75353 75354 75355 75356 75357 75358 75359 75360 75363 75364 75367 75368 75369 75370 75371 75372 75373 75374 75376 75378 75379 75380 75381 75382 75386 75387 75388 75389 75390 75391 75392 75393 75394 75395 75396 75397 75398

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

Common questions Copy link

Why do Medicare rates in Dallas, Tx 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. Dallas, Tx 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 service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. About 17 ZIP codes in Dallas, Tx 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 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 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 (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 99)

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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