Medicare payment locality · Q1 2026 release
Wisconsin WI
MAC 06302 · Locality 00This locality's GPCIs hold Medicare payments below the national average for the Q1 2026 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. Work GPCI without the 1.0 floor: 0.993.
Example rates in Wisconsin
National vs. Wisconsin non-facility amounts for common codes, Q1 2026 (before sequestration).
| Code | National | Wisconsin | Difference |
|---|---|---|---|
| 0446T | $6,320.12 | $6,054.28 | -4.2% |
| 0447T | $100.87 | $96.74 | -4.1% |
| 0448T | $6,219.58 | $5,957.28 | -4.2% |
| 0509T | $77.82 | $74.67 | -4.0% |
| 0583T | $1,505.04 | $1,442.05 | -4.2% |
| 0596T | $2,019.08 | $1,934.35 | -4.2% |
| 0597T | $596.54 | $571.61 | -4.2% |
| 0605T | $758.53 | $725.16 | -4.4% |
| 10004 | $53.11 | $49.15 | -7.5% |
| 10005 | $132.27 | $125.01 | -5.5% |
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
Wisconsin covers 919 ZIP codes across WI, per the CMS ZIP-to-locality crosswalk (Q3 2026). 1 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 Wisconsin 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. Wisconsin currently pays below the national average for the Q1 2026 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 1 ZIP codes in Wisconsin span more than one locality and need the ZIP+4 to resolve exactly.
Is Wisconsin's work GPCI held up by Medicare's 1.0 floor?
Yes. This locality's raw work GPCI is 0.993. 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?
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. Wisconsin pays below the national average, so patients here typically owe a bit less 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 Q1 2026 release (effective January 2026). 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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