Medicare payment locality · Q3 2026 release

Seattle WA Medicare Locality 02

MAC 02402 · Locality 02

Seattle (King County)

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

1.050

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.227

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

Malpractice GPCI

0.817

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 Seattle (King County) Copy link

National and Seattle (King County) 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	Seattle (King County)	Difference
99214	$135.61	$153.12	+12.9%
99213	$95.19	$107.88	+13.3%
99215	$192.39	$216.63	+12.6%
66984	$462.60	$517.83	+11.9%
99204	$177.36	$198.96	+12.2%
92014	$127.26	$147.20	+15.7%
97110	$29.06	$32.86	+13.1%
88305	$70.14	$81.47	+16.2%
97530	$35.07	$40.29	+14.9%
99203	$117.57	$132.61	+12.8%

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

Seattle (King County) covers 130 ZIP codes across WA, per the CMS ZIP-to-locality crosswalk (Q3 2026). 6 of them span more than one locality and need ZIP+4 for an exact match.

98001 98002 98003 98004 98005 98006 98007 98008 98009 98010 98011 98013 98014 98015 98019 98022 98023 98024 98025 98027 98028 98029 98030 98031 98032 98033 98034 98035 98038 98039 98040 98041 98042 98045 98047 98050 98051 98052 98053 98054 98055 98056 98057 98058 98059 98060 98062 98063 98064 98065 98070 98071 98072 98073 98074 98075 98077 98083 98089 98092 98093 98101 98102 98103 98104 98105 98106 98107 98108 98109 98111 98112 98113 98114 98115 98116 98117 98118 98119 98121 98122 98124 98125 98126 98127 98129 98130 98131 98132 98133 98134 98136 98138 98139 98140 98141 98144 98145 98146 98148 98150 98151 98154 98155 98158 98160 98161 98164 98165 98166 98168 98170 98171 98174 98175 98177 98178 98181 98184 98185 98188 98189 98190 98191 98194 98195 98198 98199 98224 98288

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

Common questions Copy link

Why do Medicare rates in Seattle (King County) 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. Seattle (King County) 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 6 ZIP codes in Seattle (King County) 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 108)

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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