Price a code in Utah Copy link
What common codes pay in Utah Copy link
99214 is $131.12 here, 3.3% below national. Across these 10 codes, local Office (non-facility) amounts run from 3.9% below to 3% below national, depending on each code's mix of work, practice-expense and malpractice RVUs.
| Code | National | Local | Difference |
|---|---|---|---|
| 99214 | $135.61 | $131.12 | -3.3% |
| 99213 | $95.19 | $91.96 | -3.4% |
| 99215 | $192.39 | $186.16 | -3.2% |
| 66984 | $462.60 | $448.46 | -3.1% |
| 99204 | $177.36 | $171.59 | -3.3% |
| 92014 | $127.26 | $122.41 | -3.8% |
| 97110 | $29.06 | $28.20 | -3.0% |
| 88305 | $70.14 | $67.37 | -3.9% |
| 97530 | $35.07 | $33.83 | -3.5% |
| 99203 | $117.57 | $113.50 | -3.5% |
Office (non-facility), Q1 2026, before sequestration; 2026 standard (non-QP) physician conversion factor $33.4009. For the facility amount, a modifier or a date of service, use the rate calculator, already set to this locality, or start from your field's procedure mix on the specialty fee schedules.
Why do Medicare rates in Utah 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. Utah currently has all three GPCIs at or below the national baseline, so services priced with the standard RVU formula usually come out below the national amount for the Q1 2026 release.
Is Utah's work GPCI held up by Medicare's 1.0 floor?
Yes. This locality's raw work GPCI is 0.985. A legislated floor holds the work GPCI at 1.000 or above, so lower local physician wages still pay at the national baseline. The floored value, 1.000, is what the payment formula uses.
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.
Which ZIP codes are in Utah? Copy link
361 ZIP codes in UT, per the CMS ZIP-to-locality crosswalk (Q1 2026).
- 84001
- 84002
- 84003
- 84004
- 84005
- 84006
- 84007
- 84008
- 84009
- 84010
- 84011
- 84013
- 84014
- 84015
- 84016
- 84017
- 84018
- 84020
- 84021
- 84022
- 84023
- 84024
- 84025
- 84026
Show all 361 ZIP codes
- 84027
- 84028
- 84029
- 84030
- 84031
- 84032
- 84033
- 84034
- 84035
- 84036
- 84037
- 84038
- 84039
- 84040
- 84041
- 84042
- 84043
- 84044
- 84045
- 84046
- 84047
- 84048
- 84049
- 84050
- 84051
- 84052
- 84053
- 84054
- 84055
- 84056
- 84057
- 84058
- 84059
- 84060
- 84061
- 84062
- 84063
- 84064
- 84065
- 84066
- 84067
- 84068
- 84069
- 84070
- 84071
- 84072
- 84073
- 84074
- 84075
- 84076
- 84078
- 84079
- 84080
- 84081
- 84082
- 84083
- 84084
- 84085
- 84086
- 84087
- 84088
- 84089
- 84090
- 84091
- 84092
- 84093
- 84094
- 84095
- 84096
- 84097
- 84098
- 84101
- 84102
- 84103
- 84104
- 84105
- 84106
- 84107
- 84108
- 84109
- 84110
- 84111
- 84112
- 84113
- 84114
- 84115
- 84116
- 84117
- 84118
- 84119
- 84120
- 84121
- 84122
- 84123
- 84124
- 84125
- 84126
- 84127
- 84128
- 84129
- 84130
- 84131
- 84132
- 84133
- 84134
- 84135
- 84136
- 84137
- 84138
- 84139
- 84140
- 84141
- 84142
- 84143
- 84144
- 84145
- 84147
- 84148
- 84150
- 84151
- 84152
- 84153
- 84157
- 84158
- 84165
- 84170
- 84171
- 84180
- 84184
- 84185
- 84189
- 84190
- 84193
- 84194
- 84195
- 84199
- 84201
- 84244
- 84301
- 84302
- 84304
- 84305
- 84306
- 84307
- 84308
- 84309
- 84310
- 84311
- 84312
- 84313
- 84314
- 84315
- 84316
- 84317
- 84318
- 84319
- 84320
- 84321
- 84322
- 84323
- 84324
- 84325
- 84326
- 84327
- 84328
- 84329
- 84330
- 84331
- 84332
- 84333
- 84334
- 84335
- 84336
- 84337
- 84338
- 84339
- 84340
- 84341
- 84401
- 84402
- 84403
- 84404
- 84405
- 84407
- 84408
- 84409
- 84412
- 84414
- 84415
- 84501
- 84510
- 84511
- 84512
- 84513
- 84515
- 84516
- 84518
- 84520
- 84521
- 84522
- 84523
- 84525
- 84526
- 84527
- 84528
- 84529
- 84530
- 84531
- 84532
- 84533
- 84534
- 84535
- 84536
- 84537
- 84539
- 84540
- 84542
- 84601
- 84602
- 84603
- 84604
- 84605
- 84606
- 84620
- 84621
- 84622
- 84623
- 84624
- 84626
- 84627
- 84628
- 84629
- 84630
- 84631
- 84632
- 84633
- 84634
- 84635
- 84636
- 84637
- 84638
- 84639
- 84640
- 84642
- 84643
- 84644
- 84645
- 84646
- 84647
- 84648
- 84649
- 84650
- 84651
- 84652
- 84653
- 84654
- 84655
- 84656
- 84657
- 84660
- 84662
- 84663
- 84664
- 84665
- 84667
- 84701
- 84710
- 84711
- 84712
- 84713
- 84714
- 84715
- 84716
- 84717
- 84718
- 84719
- 84720
- 84721
- 84722
- 84723
- 84724
- 84725
- 84726
- 84728
- 84729
- 84730
- 84731
- 84732
- 84733
- 84734
- 84735
- 84736
- 84737
- 84738
- 84739
- 84740
- 84741
- 84742
- 84743
- 84744
- 84745
- 84746
- 84747
- 84749
- 84750
- 84751
- 84752
- 84753
- 84754
- 84755
- 84756
- 84757
- 84758
- 84759
- 84760
- 84761
- 84762
- 84763
- 84764
- 84765
- 84766
- 84767
- 84770
- 84771
- 84772
- 84773
- 84774
- 84775
- 84776
- 84779
- 84780
- 84781
- 84782
- 84783
- 84784
- 84790
- 84791
Have a service address? Look up its ZIP and date of service to confirm the locality.
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. A few ZIPs nationally span multiple localities and need ZIP+4 to resolve exactly.
Have its GPCIs changed? Copy link
These GPCIs took effect January 2026: PE 0.933 → 0.940, MP 0.930 → 0.898.
| Release | Work | PE | MP |
|---|---|---|---|
| January 2026 to October 2026 (this page) | 1.000 | 0.940 | 0.898 |
| January 2024 to October 2025 | 1.000 | 0.933 | 0.930 |
| January 2023 to October 2023 | 1.000 | 0.926 | 0.865 |
| January 2021 to October 2022 | 1.000 | 0.919 | 0.799 |
| January 2020 to October 2020 | 1.000 | 0.923 | 0.982 |
| January 2018 to October 2019 | 1.000 | 0.927 | 1.165 |
| January 2017 to October 2017 | 1.000 | 0.925 | 1.167 |
| January 2015 to October 2016 | 1.000 | 0.922 | 1.169 |
| April 2014 to October 2014 | 1.000 | 0.919 | 1.136 |
| January 2013 to April 2013 | 1.000 | 0.916 | 1.102 |
Newest first; releases with unchanged GPCIs share a row.
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
-
01 GPCI2026.csv · Q1 2026 (RVU26A) · row 104—the three GPCIs limits
- Effective
- Effective January 2026
- Locator
- GPCI2026.csv in rvu26a-updated-12-29-2025.zip · row 104 of 109 · via CMS
- Fields read
-
MAC 03502 Locality 09 Work GPCI 1.000 PE GPCI 0.940 MP GPCI 0.898 Work GPCI without floor 0.985SHA-256 5e2cc8072633ccb0…
- Doesn’t establish
- An amount for any code by itself: that needs the code’s RVUs and status from the same release.
-
02 ZIP5_JAN2026.txt · Q1 2026—361 ZIP codes limits
- Source
- ZIP code to carrier locality crosswalk
- Locator
- ZIP5_JAN2026.txt in zip-code-carrier-locality-file-revised-11-18-2025.zip · via CMS
- Fields read
-
SHA-256 e10d685600543a79…
- Doesn’t establish
- Where a split ZIP’s service address falls: CMS places those by ZIP+4.
-
03 Example amounts · Q1 2026 · $33.4009—the common-code table limits
- Source
- Each code’s Office (non-facility) RVUs from the same release, × these GPCIs, × the 2026 standard (non-QP) physician conversion factor
- Effective
- Effective January 2026
- Doesn’t establish
- Facility amounts, modifier adjustments or the payment after the ~2% sequestration cut; codes outside the standard RVU formula aren’t listed.
- Note
- Past releases are never edited, so a rate for an earlier quarter always matches what CMS published for it.
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