GPCI-Adjusted Payment Calculator

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CPT or HCPCS code Selected locality Setting Non-facility Facility

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Data source CMS 2026 · Verified 2026-08-31

Data year

2026

Version

2026

Last verified

2026-08-31

Source

CMS 2026 GPCI locality file, CPT RVU file, and the 2026 non-QPP conversion factor.

Data path

Imported from the 2026 CMS-derived CPT and GPCI datasets stored in WordPress options.

Scope

United States CMS locality assumptions.

Formula

The same CPT is recalculated across CMS localities using the selected facility setting and 2026 non-QPP conversion factor.

Open source

Medicare does not pay the same amount for CPT 99214 in San Jose as it does in rural Arkansas — the gap between the highest- and lowest-paying localities for this single code is $46.10, or roughly 37% of the national payment. Understanding why requires unpacking three layers: the Relative Value Unit (RVU) structure, the Geographic Practice Cost Index (GPCI), and the annual conversion factor. This calculator lets you isolate each variable and see exactly how CMS converts a code into a dollar amount for any of the 110+ Medicare payment localities.

How Medicare Builds a Payment

Every Medicare Physician Fee Schedule (MPFS) payment is built from the same formula, regardless of specialty or setting:

Payment = [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor

This is the Resource-Based Relative Value Scale (RBRVS) methodology CMS has used since 1992, and it’s the engine behind every number this calculator produces. Each CPT or HCPCS code carries three national RVU components — work, practice expense (PE), and malpractice (MP) — that CMS assigns based on clinical labor, overhead, and liability risk. Those RVUs are national constants; they don’t change by location. What changes by location is the GPCI, which scales each component up or down to reflect local cost-of-living and practice-cost differences before the conversion factor turns the total into a dollar figure.

Reading the CPT 99214 Example

For CPT 99214 (established patient office visit, moderate medical decision-making or 30–39 minutes total time), the CY 2026 MPFS assigns a work RVU of 1.92, a non-facility PE RVU of 2.00, and an MP RVU of 0.14, for a total non-facility RVU of 4.06. This work RVU has held steady since the 2021 office-visit E/M overhaul and was explicitly exempted from CMS’s new 2026 “efficiency adjustment,” which did reduce facility-setting PE RVUs for many E/M codes by over 40% this year.

At the national locality, all three GPCI factors are normalized to 1.000 — this is what the calculator shows as “Selected work GPCI: 1,” “Selected PE GPCI: 1,” and “Selected MP GPCI: 1.” Multiplying 4.06 total RVU by the CY 2026 non-facility conversion factor of $33.4009 (finalized under CMS-1832-F) yields $135.61, exactly matching the calculator’s default result.

Why Locality Changes the Answer

Once you swap “national” for an actual CMS locality slug, each RVU component gets multiplied by that locality’s specific GPCI value instead of 1.000. The calculator’s two extremes illustrate this clearly:

San Jose-Sunnyvale-Santa Clara (San Benito County), California carries a work GPCI of 1.110 and a PE GPCI of 1.442 — the highest PE GPCI in the country, driven by office rent and staff wages in the Bay Area. Applying these to 99214’s RVUs: (1.92 × 1.110) + (2.00 × 1.442) + (0.14 × MP GPCI) = 5.09 total adjusted RVU, which at $33.4009 produces the calculator’s stated $170.02 — the highest payment among all 110 comparison localities.

Arkansas (statewide) sits at the opposite end, with a work GPCI of 1.000, a PE GPCI of 0.859, and an MP GPCI of 0.515 — among the lowest PE and MP indices nationally. Running the same formula: (1.92 × 1.000) + (2.00 × 0.859) + (0.14 × 0.515) = 3.71 total adjusted RVU, which at $33.4009 yields $123.92, matching the calculator’s lowest-payment figure exactly.

This $46.10 spread — labeled “Payment spread” in the tool — is not noise or rounding; it’s the deliberate output of a statutory formula CMS uses to equalize purchasing power across markets with very different labor and real-estate costs.

The 2026 Conversion Factor Split

A structural change worth flagging for anyone modeling payments this year: CY 2026 introduced two separate statutory conversion factors instead of one. Clinicians who qualify as Advanced Alternative Payment Model participants (QP) use $33.5675, while all other physicians and practitioners (non-QP) use $33.4009 — both up from the 2025 conversion factor of $32.35 following a statutory 2.5% update plus separate QP/non-QP adjustments. This calculator’s default results reflect the non-QP rate, which applies to the large majority of billing physicians. If your practice or a specific provider has QP status under MIPS/APM tracking, the actual payment will run about 0.5% higher than what’s shown here.

The GPCI Floor Issue Coders Should Track

One policy detail that materially affects this calculator’s outputs for many localities: the permanent 1.0 statutory floor on the work GPCI — which historically prevented any locality from having a work GPCI below the national average — expired on September 30, 2025, and CMS has stated it lacks authority to extend it without new legislation. The CY 2026 Geographic Adjustment Factor tables do not reflect this floor, meaning states like Arkansas, Iowa, Kansas, and Mississippi that previously benefited from the floor now see their true, unfloored work GPCI applied, which can lower payments in those areas relative to prior years. If Congress passes retroactive floor-extension legislation during 2026, CMS would need to reissue updated GPCI tables, and any locality-specific results in this calculator tied to sub-1.0 work GPCI values should be rechecked against the latest MPFS release at that point.

Practical Uses for Coders and Practice Managers

For a practice manager comparing expansion sites, running the same CPT code across multiple candidate localities in this calculator quickly quantifies the reimbursement delta before a lease or staffing decision is made — a $46.10 per-visit gap on a high-volume E/M code compounds fast across thousands of annual encounters. For coders and billers, the tool is most useful for auditing whether a payer’s remittance matches the expected CMS allowable for a given locality and setting (facility vs. non-facility), since PE RVU — and therefore total payment — can differ by more than 75% between the two settings for the same code, as seen in 99214’s $135.61 non-facility versus $84.50 facility split. Always confirm the locality slug precisely; CMS locality boundaries follow MSA-based (Metropolitan Statistical Area) definitions since the 2017 PAMA reform, so “California” alone is not specific enough — San Jose-Sunnyvale-Santa Clara is a distinct locality from “Rest of California,” with meaningfully different GPCI values.