Medicare payment locality · Q3 2026 release

Houston, Tx TX Medicare Locality 18

MAC 04412 · Locality 18

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

1.008

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

0.993

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

Malpractice GPCI

1.376

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 Houston, Tx Copy link

National vs. Houston, 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	Houston, Tx	Difference
99214	$135.61	$137.41	+1.3%
99213	$95.19	$96.33	+1.2%
99215	$192.39	$195.13	+1.4%
66984	$462.60	$469.86	+1.6%
99204	$177.36	$180.49	+1.8%
92014	$127.26	$127.59	+0.3%
97110	$29.06	$29.21	+0.5%
88305	$70.14	$70.27	+0.2%
97530	$35.07	$35.17	+0.3%
99203	$117.57	$119.60	+1.7%

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

Houston, Tx covers 243 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.

77001 77002 77003 77004 77005 77006 77007 77008 77009 77010 77011 77012 77013 77014 77015 77016 77017 77018 77019 77020 77021 77022 77023 77024 77025 77026 77027 77028 77029 77030 77031 77032 77033 77034 77035 77036 77037 77038 77039 77040 77041 77042 77043 77044 77045 77046 77047 77048 77049 77050 77051 77052 77054 77055 77056 77057 77058 77059 77060 77061 77062 77063 77064 77065 77066 77067 77068 77069 77070 77071 77072 77073 77074 77075 77076 77077 77078 77079 77080 77081 77082 77083 77084 77085 77086 77087 77088 77089 77090 77091 77092 77093 77094 77095 77096 77097 77098 77099 77201 77202 77203 77204 77205 77206 77207 77208 77209 77210 77212 77213 77215 77216 77217 77218 77219 77220 77221 77222 77223 77224 77225 77226 77227 77228 77229 77230 77231 77233 77234 77235 77236 77237 77238 77240 77241 77242 77243 77244 77245 77246 77247 77248 77249 77250 77251 77252 77253 77254 77255 77256 77257 77258 77259 77260 77261 77262 77263 77265 77266 77267 77268 77269 77270 77271 77272 77273 77274 77275 77276 77277 77278 77279 77280 77281 77282 77284 77285 77286 77287 77288 77289 77290 77291 77292 77293 77294 77296 77297 77298 77299 77315 77325 77336 77337 77338 77339 77345 77346 77347 77373 77375 77377 77379 77383 77388 77389 77391 77396 77401 77402 77410 77411 77413 77429 77433 77447 77449 77450 77484 77491 77492 77493 77501 77502 77503 77504 77505 77506 77507 77508 77520 77521 77522 77530 77532 77536 77547 77562 77571 77572 77586 77587 77598

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

Common questions Copy link

Why do Medicare rates in Houston, 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. Houston, 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 12 ZIP codes in Houston, 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 102)

ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Did this answer your question about Houston, Tx (TX)?

We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.