There is no single “highest GPCI state” for every Medicare payment estimate. GPCI is split into Work, practice expense (PE), and malpractice (MP) components, and the highest value depends on the component and the specific payment locality. A state-level ranking that combines the three factors into one number can mislead users.
The table below uses the current 2026 locality records loaded into the RVUinUSA calculator. It identifies high-value localities by component; it is not a universal CMS ranking or a recommendation to use a state average.
Highest localities by GPCI component
| Component | Highest locality in the current dataset | Factor | Other high localities |
|---|---|---|---|
| Work GPCI | Alaska | 1.500 | San Jose, California: 1.110; Manhattan, New York: 1.064 |
| PE GPCI | San Jose, California | 1.442 | San Francisco, California: 1.410; Napa, California: 1.318 |
| MP GPCI | Miami, Florida | 2.529 | Chicago, Illinois: 2.295; East St. Louis, Illinois: 2.014 |
The highest entries are locality records, not statewide averages. California, New York, and Florida each contain multiple localities, so the state name alone is insufficient to reproduce a result.
Why the highest Work, PE, and MP values differ
Each component represents a different cost or resource category:
- Work GPCI: adjusts the physician-work component.
- PE GPCI: adjusts the selected facility or non-facility practice-expense component.
- MP GPCI: adjusts the malpractice component.
A code with a large work RVU responds more to Work GPCI. An office service with a large non-facility PE RVU responds more to PE GPCI. A procedure with a relatively large MP RVU can be more sensitive to MP GPCI. Therefore, a locality with the highest value in one column is not automatically the highest-payment locality for every CPT code.
Do not create a composite state ranking without a code
Payment is calculated from the code’s RVU components, the selected setting, the three locality factors, and the conversion factor:
Adjusted total RVU =
(Work RVU x Work GPCI)
+ (Selected PE RVU x PE GPCI)
+ (MP RVU x MP GPCI)
Payment estimate =
Adjusted total RVU x Conversion FactorWithout a CPT code and setting, “highest GPCI state” has no single payment meaning. A valid comparison must hold the code, setting, participant status, and data year constant, then change only the locality.
Example: compare one code across localities
For CPT 99213 in the non-facility setting, use the 2026 database values of 1.30 work RVU, 1.46 PE RVU, and 0.09 MP RVU. Then choose a locality in the RVU Calculator. The result will show the effect of the locality without pretending that one state-wide number applies to every code.
For a direct locality comparison, open the GPCI Calculator and keep the CPT code and setting fixed. Record the locality name with each result; do not copy only the highest factor.
How to use a high-GPCI ranking responsibly
- Use the ranking as a screening signal, not as a payment answer.
- Identify the actual practice locality rather than choosing a state with a high factor.
- Apply the factor to the matching RVU component only.
- Compare the same CPT code and setting across localities.
- Verify the current CMS source row before a billing or contract decision.
GPCI is not a compensation benchmark
GPCI changes a Medicare payment estimate. A physician compensation plan may use work RVU credit and a negotiated dollars-per-wRVU rate without applying GPCI. A high Medicare GPCI does not prove that a compensation offer is higher or fairer.
FAQ
Which state has the highest GPCI?
That depends on the component. In the current dataset, Alaska has the highest Work GPCI locality, while Miami has the highest MP GPCI locality and San Jose has the highest PE GPCI locality.
Can I rank states by averaging Work, PE, and MP GPCI?
Not for a general payment answer. The correct weighting comes from the selected CPT code’s RVU components and setting.
Does a high GPCI increase work RVU credit?
No. GPCI adjusts Medicare payment modeling. Contract credit depends on the written compensation terms.