Medicare payment locality · Q2 2025 release
Houston TX
MAC 04412 · Locality 18This locality's GPCIs lift Medicare payments above the national average for the Q2 2025 Physician Fee Schedule. Every code below takes the national amount and rescales it by those three indexes.
1.000 is the national baseline. Above raises that component; below lowers it.
Example rates in Houston
National vs. Houston non-facility amounts for common codes, Q2 2025 (before sequestration).
| Code | National | Houston | Difference |
|---|---|---|---|
| 0275T | $0.00 | $0.00 | — |
| 0446T | $5,846.63 | $5,865.63 | +0.3% |
| 0447T | $95.42 | $97.10 | +1.8% |
| 0448T | $5,493.08 | $5,511.82 | +0.3% |
| 0509T | $73.10 | $73.73 | +0.9% |
| 10004 | $51.75 | $53.90 | +4.2% |
| 10005 | $129.06 | $132.07 | +2.3% |
| 10006 | $58.22 | $60.07 | +3.2% |
| 10007 | $294.03 | $298.58 | +1.5% |
| 10008 | $137.47 | $140.41 | +2.1% |
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
Houston 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.
Not sure which locality your ZIP is in? Look it up by ZIP code.
Common questions
Why do Medicare rates in Houston differ from the national amount?
Medicare scales each code's work, practice-expense, and malpractice RVUs by this locality's three GPCIs before applying the conversion factor. Local labor, rent, and liability costs therefore move the final amount up or down. Houston currently pays above the national average for the Q2 2025 release.
How do I know if my address is in this locality?
Medicare assigns localities by ZIP code rather than by city or county lines, so neighboring addresses can fall in different localities. Look up your ZIP to find your locality. About 12 ZIP codes in Houston span more than one locality and need the ZIP+4 to resolve exactly.
Do commercial insurers or Medicare Advantage plans use this locality?
No. Medicare payment localities belong to Original Medicare's Physician Fee Schedule alone. Medicare Advantage plans and commercial insurers set their own geographic adjustments and negotiated network rates. They're free to draw their own boundaries, though many still benchmark off the Medicare amount.
Does my locality affect what I owe as a patient?
Yes. Original Medicare calculates your 20% coinsurance on the locality-adjusted amount rather than the national one. The same code can therefore leave you owing more or less depending on where you're treated. Houston pays above the national average, so patients here typically owe a bit more in coinsurance than the national amount would suggest.
Why did my Medicare payment change even though I didn't change what I billed?
GPCIs and the conversion factor update with each quarterly CMS release (January, April, July, October). The same code in the same locality can therefore pay a different amount quarter to quarter, with nothing on your end changing. See what changed each release.
Source & method
GPCIs and rates computed from the CMS Medicare Physician Fee Schedule Q2 2025 release (effective April 2025). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release. Example amounts take the national non-facility figures and rescale them by this locality's GPCIs, before the ~2% sequestration cut. Releases are immutable: a rate retrieved for a past quarter always reflects that release.
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