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District of Columbia Medicare fee schedule 2026: locality 12202-01

District of Columbia is a single Medicare payment locality, so one set of 2026 geographic practice cost indices prices every physician fee schedule service in the state. This page gives those indices, what common codes pay against the national amount, the counties and ZIP codes CMS assigns to the locality, and the statewide DMEPOS amounts.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: PFS GPCIs, anesthesia conversion factors and localities: CY2026 Addendum E (RVU26D) (effective January 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); ZIP code to carrier locality file: ZIP5 October 2026 (file updated August 13, 2026) (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026). Next CMS release: CY2027 PFS final rule (November 2026), effective January 1, 2027 for the PFS GPCIs, anesthesia conversion factors and localities; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; January 1, 2027 (quarterly update) for the ZIP code to carrier locality file and DMEPOS fee schedule.

TL;DR

District of Columbia is a single Medicare payment locality (12202-01, contractor 12202). Its 2026 indices are 1.054 for work, 1.178 for practice expense and 1.113 for malpractice, a geographic adjustment factor of 1.112 (+11.2% against the national 1.000, rank 12 of 109). In an office, 99213 pays $106.56 here against $95.19 nationally, G2211 $19.05 against $17.37 and G0439 $153.87 against $137.61. The locality takes in District of Columbia; Alexandria City, Arlington, Fairfax, Fairfax City, Falls Church City in Virginia; Montgomery and Prince George's in Maryland, 591 ZIP codes in the October 2026 file.

Locality 12202-01 at a glance

Contractor and locality
12202-01
Novitas Solutions, Inc.
Geographic adjustment factor
1.112
+11.2% vs national, rank 12 of 109
Anesthesia conversion factor
$22.06
QP $22.17; national $20.50
ZIP codes
591
1 rural, 0 super rural
DMEPOS rural ZIP codes
0
on the quarter 4 2026 list

2026 GPCIs for District of Columbia

2026 geographic practice cost indices for Medicare locality 12202-01
ComponentGPCIvs national 1.000
Work (physician time and effort)1.054+5.4%
Practice expense (staff, rent, equipment, supplies)1.178+17.8%
Malpractice (professional liability insurance)1.113+11.3%
Geographic adjustment factor (weighted)1.112+11.2%

A fee schedule amount here is [(work RVU x 1.054) + (practice expense RVU x 1.178) + (malpractice RVU x 1.113)] x the conversion factor. The practice expense index weighs most on office services, whose non-facility practice expense RVU carries the practice's overhead, while the work index weighs most on surgery and other physician-intensive services. The work index is above the 1.0 floor, so the floor does not affect this locality.

Example payments in District of Columbia

Amounts at the non-QP conversion factor for one unit of the global service, computed from the RVU26D store with this locality's indices; the national column uses indices of 1.000. CPT numbers are shown without descriptors. Open a code to see every modifier row, both conversion factors and the payment indicators.

2026 Medicare physician fee schedule amounts in District of Columbia and nationally for example codes
CodeOffice (non-facility)NationalFacilityvs national
99213CPT number$106.56$95.19$62.10+11.9%
99214CPT number$151.49$135.61$91.29+11.7%
G2211$19.05$17.37$15.51+9.7%
G0439$153.87$137.61$153.87+11.8%
G0402$194.64$174.69$123.43+11.4%
20610CPT number$77.58$68.81$43.35+12.7%

Counties and ZIP codes in locality 12202-01

The CMS locality file defines DC + MD/VA Suburbs as District of Columbia; Alexandria City, Arlington, Fairfax, Fairfax City, Falls Church City in Virginia; Montgomery and Prince George's in Maryland. The October 2026 ZIP code file assigns 591 ZIP codes to it, 140 of them listed under MD and 132 of them listed under VA; 1 are flagged rural and 0 super rural for physician fee schedule purposes, and 7 are split by ZIP+4, so for an address in one of those the ZIP+4 file decides the locality.

Three-digit ZIP prefixes in Medicare locality 12202-01
ZIP prefixZIP codes
200xx78
201xx16
202xx53
203xx34
204xx50
205xx73
206xx5
207xx58
208xx59
209xx18
220xx30
221xx30
222xx33
223xx23
569xx30
888xx1
Every ZIP code in locality 12202-01 (170 ranges)

20001-20013, 20015-20020, 20022-20024, 20026-20027, 20029-20030, 20032-20033, 20035-20047, 20049-20053, 20055-20071, 20073-20078, 20080-20082, 20088, 20090-20091, 20097-20099, 20120-20122, 20124, 20151, 20153, 20170-20172, 20190-20196, 20201-20204, 20206-20208, 20210-20224, 20226-20233, 20235, 20237-20242, 20244-20245, 20250-20252, 20254, 20260-20262, 20265-20266, 20268, 20270, 20277, 20289, 20299, 20301, 20303, 20306-20307, 20310, 20314-20315, 20317-20319, 20330, 20332, 20336-20338, 20340, 20350, 20355, 20370, 20372-20376, 20380, 20388-20395, 20398, 20401-20429, 20431, 20433-20437, 20439-20442, 20444, 20447, 20451, 20453, 20456, 20460, 20463, 20468-20470, 20472, 20500-20511, 20515, 20520-20544, 20546-20555, 20557-20560, 20565-20566, 20570-20573, 20575-20581, 20585-20586, 20590-20591, 20593-20594, 20597, 20599, 20607-20608, 20613, 20623, 20697, 20703-20710, 20712, 20715-20722, 20725-20726, 20731, 20735, 20737-20738, 20740-20750, 20752-20753, 20757, 20762, 20768-20775, 20781-20785, 20787-20788, 20790-20792, 20797, 20799, 20810-20818, 20824-20825, 20827, 20830, 20832-20833, 20837-20839, 20841-20842, 20847-20855, 20857, 20859-20862, 20866, 20868, 20871-20872, 20874-20880, 20882-20886, 20889, 20891-20892, 20894-20899, 20901-20908, 20910-20916, 20918, 20993, 20997, 22003, 22009, 22015, 22027, 22030-22044, 22046-22047, 22060, 22066-22067, 22079, 22081-22082, 22092, 22095-22096, 22101-22103, 22106-22109, 22116, 22118-22122, 22124, 22150-22153, 22156, 22158-22161, 22180-22185, 22199, 22201-22207, 22209-22219, 22222-22223, 22225-22227, 22229-22230, 22234, 22240-22246, 22301-22315, 22320-22321, 22331-22334, 22336, 22350, 56901-56902, 56904, 56908, 56915, 56920, 56933, 56935, 56944-56945, 56950, 56963-56973, 56980-56985, 56998-56999, 88888

Localities with a similar adjustment

Ranked by geographic adjustment factor, the localities on either side of DC + MD/VA Suburbs are Seattle (King County), WA (1.119) and Northern NJ, NJ (1.107). Localities with the same GAF can still pay a given code differently when their work and practice expense indices are mixed in different proportions.

DMEPOS amounts in District of Columbia

Durable medical equipment, prosthetics, orthotics and supplies are not priced by locality. The October 2026 DMEPOS fee schedule (DME26-D) sets one non-rural and one rural amount per code for the whole state, and the rural amount applies only in the ZIP codes on the quarterly DMEPOS rural list. The table shows the District of Columbia amounts for common items next to the lowest and highest non-rural amount among the contiguous states; HCPCS Level II descriptors are CMS's.

DMEPOS fee schedule amounts in District of Columbia, October 2026
CodeItemNon-ruralRuralContiguous states
E0601-RRContinuous positive airway pressure (cpap) devicecapped rental, monthly rental$50.04$94.64$50.04 to $52.65
E0260-RRHospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattresscapped rental, monthly rental$74.43$128.14$72.80 to $78.16
K0001-RRStandard wheelchaircapped rental, monthly rental$26.42$53.64$25.23 to $31.07
E0143-NUWalker, folding, wheeled, adjustable or fixed heightinexpensive or routinely purchased, purchased new$57.03$106.25$55.55 to $60.89
E0114-NUCrutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgripsinexpensive or routinely purchased, purchased new$67.26—$57.17 to $67.26
A4253-NUBlood glucose test or reagent strips for home blood glucose monitor, per 50 stripsinexpensive or routinely purchased, purchased new$8.32—$8.32 in every state
L1833Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelfprosthetics and orthotics$503.87$684.50$455.16 to $556.31
E0784-RRExternal ambulatory infusion pump, insulincapped rental, monthly rental$557.75$576.36$557.75 in every state
Former competitive bidding areas use CMS's separate former CBA fee schedule for the items it lists; see the DMEPOS fee schedule page.

Contractor, coverage and other payment systems

Part B claims in this locality are processed by Novitas Solutions, Inc., whose local coverage determinations decide which services are covered and with which diagnoses. The locality adjusts only physician fee schedule payments. Clinical laboratory tests are paid at one national amount from the Clinical Laboratory Fee Schedule, hospital outpatient services through APCs adjusted by each hospital's wage index rather than by these indices, and Part B drugs at the national ASP payment limits. QuickIntell's District of Columbia page covers the state's payers and revenue-cycle requirements.

Where QuickIntell fits for District of Columbia practices

Contract management in QuickRCM keeps payer contracts and fee schedules with their effective dates and compares expected reimbursement against allowed amounts, so a claim priced at the wrong locality, or with last year's indices, is reviewed before a dispute is opened.

See contract management in QuickRCMSee QuickRCMBook a meeting

Frequently asked questions

What are the 2026 GPCIs for DC + MD/VA Suburbs?

Work 1.054, practice expense 1.178 and malpractice 1.113 for locality 12202-01, a geographic adjustment factor of 1.112.

How much does Medicare pay for 99213 in DC + MD/VA Suburbs?

$106.56 in an office and $62.10 in a facility setting at the 2026 non-QP conversion factor, against $95.19 and $57.45 nationally. Medicare pays 80% of the allowed amount after the Part B deductible.

Which ZIP codes are in Medicare locality 12202-01?

591 ZIP codes in the October 2026 CMS ZIP file, in the prefixes 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 220 and 221 and others, including 140 listed under MD and 132 listed under VA. 1 are rural and 0 super rural in that file.

Who processes Part B claims for DC + MD/VA Suburbs?

Novitas Solutions, Inc., under contractor number 12202. The same contractor writes the local coverage determinations that apply to the locality.

More on Medicare localities

Every locality and the ZIP code finder are on the Medicare payment localities hub; the national GPCI table with anesthesia conversion factors is on the physician fee schedule page, and the fee schedules hub maps which CMS schedule pays which claim.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Operational reference compiled from CMS physician fee schedule and DMEPOS public use files. Amounts are Medicare fee schedule amounts before the deductible, coinsurance, sequestration and claim-level reductions; Medicare Advantage and commercial contracts set their own rates. CPT codes appear as bare numbers; CPT descriptors are copyright AMA. Not legal, coding or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.