TL;DR
Rest of Pennsylvania is Medicare payment locality 99 of contractor 12502 in Pennsylvania, one of 2 localities in the state. Its 2026 indices are 1.000 for work, 0.918 for practice expense and 0.945 for malpractice, a geographic adjustment factor of 0.961 (-3.9% against the national 1.000, rank 88 of 109). In an office, 99213 pays $91.03 here against $95.19 nationally, G2211 $16.87 against $17.37 and G0439 $131.70 against $137.61. The locality takes in All Other Counties, 1,882 ZIP codes in the October 2026 file.
Locality 12502-99 at a glance
- Contractor and locality
- 12502-99
- Novitas Solutions, Inc.
- Geographic adjustment factor
- 0.961
- -3.9% vs national, rank 88 of 109
- Anesthesia conversion factor
- $20.18
- QP $20.28; national $20.50
- ZIP codes
- 1,882
- 776 rural, 31 super rural
- DMEPOS rural ZIP codes
- 713
- on the quarter 4 2026 list
2026 GPCIs for Rest of Pennsylvania
| Component | GPCI | vs national 1.000 |
|---|---|---|
| Work (physician time and effort) | 1.000 | +0.0% |
| Practice expense (staff, rent, equipment, supplies) | 0.918 | -8.2% |
| Malpractice (professional liability insurance) | 0.945 | -5.5% |
| Geographic adjustment factor (weighted) | 0.961 | -3.9% |
A fee schedule amount here is [(work RVU x 1.000) + (practice expense RVU x 0.918) + (malpractice RVU x 0.945)] 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 sits on the 1.0 floor that Congress extended through January 1, 2027; without it the index here would be lower.
Example payments in Rest of Pennsylvania
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.
| Code | Office (non-facility) | National | Facility | vs national |
|---|---|---|---|---|
| 99213CPT number | $91.03 | $95.19 | $56.38 | -4.4% |
| 99214CPT number | $129.87 | $135.61 | $82.96 | -4.2% |
| G2211 | $16.87 | $17.37 | $14.11 | -2.9% |
| G0439 | $131.70 | $137.61 | $131.70 | -4.3% |
| G0402 | $167.64 | $174.69 | $112.14 | -4.0% |
| 20610CPT number | $65.39 | $68.81 | $38.71 | -5.0% |
Counties and ZIP codes in locality 12502-99
The CMS locality file defines Rest of Pennsylvania as All Other Counties (fee schedule area Rest of State). The October 2026 ZIP code file assigns 1,882 ZIP codes to it; 776 are flagged rural and 31 super rural for physician fee schedule purposes, and 9 are split by ZIP+4, so for an address in one of those the ZIP+4 file decides the locality.
| ZIP prefix | ZIP codes |
|---|---|
| 150xx | 77 |
| 151xx | 32 |
| 152xx | 78 |
| 153xx | 58 |
| 154xx | 73 |
| 155xx | 40 |
| 156xx | 78 |
| 157xx | 66 |
| 158xx | 31 |
| 159xx | 46 |
| 160xx | 42 |
| 161xx | 45 |
| 162xx | 46 |
| 163xx | 49 |
| 164xx | 35 |
| 165xx | 30 |
| 166xx | 75 |
| 167xx | 24 |
| 168xx | 59 |
| 169xx | 34 |
| 170xx | 95 |
| 171xx | 26 |
| 172xx | 54 |
| 173xx | 60 |
| 174xx | 9 |
| 175xx | 61 |
| 176xx | 11 |
| 177xx | 51 |
| 178xx | 63 |
| 179xx | 49 |
| 180xx | 61 |
| 181xx | 9 |
| 182xx | 39 |
| 183xx | 41 |
| 184xx | 58 |
| 185xx | 18 |
| 186xx | 41 |
| 187xx | 22 |
| 188xx | 38 |
| 195xx | 45 |
| 196xx | 13 |
Every ZIP code in locality 12502-99 (436 ranges)
15001, 15003-15007, 15009-15010, 15012, 15014-15015, 15017-15022, 15024-15028, 15030-15038, 15042-15047, 15049-15057, 15059-15069, 15071-15072, 15074-15078, 15081-15091, 15095-15096, 15101-15102, 15104, 15106, 15108, 15110, 15112, 15116, 15120, 15122-15123, 15126-15127, 15129-15137, 15139-15140, 15142-15148, 15189, 15201-15244, 15250-15255, 15257-15268, 15270, 15272, 15274-15279, 15281-15283, 15285-15286, 15289-15290, 15295, 15301, 15310-15317, 15320-15325, 15327, 15329-15334, 15336-15342, 15344-15354, 15357-15368, 15370, 15376-15380, 15401, 15410-15413, 15415-15417, 15419-15425, 15427-15440, 15442-15451, 15454-15456, 15458-15470, 15472-15480, 15482-15486, 15488-15490, 15492, 15501-15502, 15510, 15520-15522, 15530-15542, 15544-15555, 15557-15565, 15601, 15605-15606, 15610-15613, 15615-15642, 15644, 15646-15647, 15650, 15655-15656, 15658, 15660-15666, 15668, 15670-15693, 15695-15698, 15701, 15705, 15710-15717, 15720-15725, 15727-15734, 15736-15742, 15744-15748, 15750-15754, 15756-15765, 15767, 15770-15781, 15783-15784, 15801, 15821-15825, 15827-15829, 15831-15832, 15834, 15840-15841, 15845-15849, 15851, 15853, 15856-15857, 15860-15861, 15863-15866, 15868, 15870, 15901-15902, 15904-15907, 15909, 15915, 15920-15931, 15934-15938, 15940, 15942-15946, 15948-15949, 15951-15963, 16001-16003, 16016-16018, 16020-16025, 16027-16030, 16033-16041, 16045-16046, 16048-16059, 16061, 16063, 16066, 16101-16103, 16105, 16107-16108, 16110-16117, 16120-16121, 16123-16125, 16127, 16130-16134, 16136-16137, 16140-16143, 16145-16146, 16148, 16150-16151, 16153-16157, 16159-16161, 16172, 16201, 16210-16218, 16220-16226, 16228-16230, 16232-16236, 16238-16240, 16242, 16244-16246, 16248-16250, 16253-16263, 16301, 16311-16314, 16316-16317, 16319, 16321-16323, 16326-16329, 16331-16335, 16340-16347, 16350-16354, 16360-16362, 16364-16375, 16388, 16401-16407, 16410-16413, 16415-16417, 16420-16424, 16426-16428, 16430, 16432-16436, 16438, 16440-16444, 16475, 16501-16512, 16514-16515, 16522, 16530-16534, 16538, 16541, 16544, 16546, 16550, 16553-16554, 16558, 16563, 16565, 16601-16603, 16611, 16613-16614, 16616-16617, 16619-16625, 16627, 16629-16631, 16633-16641, 16644-16648, 16650-16652, 16654-16657, 16659-16675, 16677-16686, 16689, 16691-16695, 16698-16699, 16701, 16720, 16724-16735, 16738, 16740, 16743-16746, 16748-16751, 16801-16805, 16820-16823, 16825-16830, 16832-16841, 16843-16845, 16847-16856, 16858-16861, 16863-16866, 16868, 16870-16879, 16881-16882, 16901, 16910-16912, 16914-16915, 16917-16918, 16920-16923, 16925-16930, 16932-16933, 16935-16943, 16945-16948, 16950, 17001-17078, 17080-17091, 17093-17094, 17097-17099, 17101-17113, 17120-17130, 17140, 17177, 17201-17202, 17210-17215, 17217, 17219-17225, 17228-17229, 17231-17233, 17235-17241, 17243-17244, 17246-17247, 17249-17257, 17260-17268, 17270-17272, 17294, 17301-17304, 17306-17307, 17309-17327, 17329, 17331-17335, 17337, 17339-17340, 17342-17347, 17349-17350, 17352-17356, 17358, 17360-17366, 17368, 17370-17372, 17375, 17401-17408, 17415, 17501-17509, 17512, 17516-17522, 17527-17529, 17532-17538, 17540, 17543, 17545, 17547, 17549-17552, 17554-17555, 17557, 17560, 17562-17570, 17572-17573, 17575-17585, 17601-17608, 17611, 17622, 17699, 17701-17703, 17705, 17720-17724, 17726-17731, 17735, 17737-17740, 17742-17745, 17747-17752, 17754, 17756, 17758-17760, 17762-17765, 17767-17774, 17776-17779, 17801, 17810, 17812-17815, 17820-17825, 17827-17837, 17839-17847, 17850-17851, 17853, 17855-17862, 17864-17868, 17870, 17872, 17876-17878, 17880-17889, 17901, 17920-17923, 17925, 17927, 17929-17936, 17938, 17941-17946, 17948-17949, 17951-17954, 17957, 17959-17961, 17963-17968, 17970, 17972, 17974, 17976, 17978-17983, 17985, 18001-18003, 18005, 18010-18018, 18020, 18025, 18030-18032, 18034-18038, 18040, 18042-18046, 18049-18053, 18055-18056, 18058-18060, 18062-18069, 18071-18072, 18078-18080, 18083, 18085-18088, 18091-18092, 18098-18099, 18101-18106, 18109, 18175, 18195, 18201-18202, 18210-18212, 18214, 18216, 18218-18225, 18229-18232, 18234-18235, 18237, 18239-18252, 18254-18256, 18301-18302, 18320-18328, 18330-18337, 18340-18344, 18346-18357, 18360, 18370-18373, 18401, 18403, 18405, 18407, 18410-18411, 18413-18417, 18419-18421, 18424-18428, 18430-18431, 18433-18441, 18443-18449, 18451-18466, 18469-18473, 18501-18505, 18507-18510, 18512, 18514-18515, 18517-18519, 18522, 18540, 18577, 18601-18603, 18610-18612, 18614-18619, 18621-18632, 18634-18636, 18640-18644, 18651, 18653-18657, 18660-18661, 18690, 18701-18711, 18761-18769, 18773-18774, 18801, 18810, 18812-18818, 18820-18834, 18837, 18839-18840, 18842-18848, 18850-18851, 18853-18854, 19501, 19503-19508, 19510-19512, 19516-19519, 19522-19523, 19526, 19529-19530, 19533-19536, 19538-19545, 19547-19551, 19554-19555, 19557, 19559-19560, 19562, 19564-19565, 19567, 19601-19612, 19640
Other localities in Pennsylvania
| Locality | GAF | vs Rest of Pennsylvania | ZIP codes |
|---|---|---|---|
| Metropolitan Philadelphia | 1.036 | +7.8% | 363 |
All 2 localities with their counties are compared on the Pennsylvania Medicare fee schedule page.
Localities with a similar adjustment
Ranked by geographic adjustment factor, the localities on either side of Rest of Pennsylvania are Rest of New York, NY (0.965) and Ohio, OH (0.961). 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 Pennsylvania
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 Pennsylvania amounts for common items next to the lowest and highest non-rural amount among the contiguous states; HCPCS Level II descriptors are CMS's.
| Code | Item | Non-rural | Rural | Contiguous states |
|---|---|---|---|---|
| E0601-RR | Continuous positive airway pressure (cpap) devicecapped rental, monthly rental | $50.04 | $91.18 | $50.04 to $52.65 |
| E0260-RR | Hospital 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-RR | Standard wheelchaircapped rental, monthly rental | $26.42 | $53.64 | $25.23 to $31.07 |
| E0143-NU | Walker, folding, wheeled, adjustable or fixed heightinexpensive or routinely purchased, purchased new | $57.03 | $106.25 | $55.55 to $60.89 |
| E0114-NU | Crutches 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-NU | Blood 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 |
| L1833 | Knee 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-RR | External ambulatory infusion pump, insulincapped rental, monthly rental | $557.75 | $576.42 | $557.75 in every state |
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 Pennsylvania page covers the state's payers and revenue-cycle requirements.
Where QuickIntell fits for Pennsylvania 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.
Frequently asked questions
What are the 2026 GPCIs for Rest of Pennsylvania?
Work 1.000, practice expense 0.918 and malpractice 0.945 for locality 12502-99, a geographic adjustment factor of 0.961. The work index sits on the 1.0 floor that Congress extended through January 1, 2027.
How much does Medicare pay for 99213 in Rest of Pennsylvania?
$91.03 in an office and $56.38 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 12502-99?
1,882 ZIP codes in the October 2026 CMS ZIP file, in the prefixes 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, 160 and 161 and others. 776 are rural and 31 super rural in that file.
Who processes Part B claims for Rest of Pennsylvania?
Novitas Solutions, Inc., under contractor number 12502. 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.
- CY2026 geographic practice cost indices by Medicare locality (Addendum E)Version CY2026 Addendum E (RVU26D) · effective 2026-01-01 · file GPCI2026.csvSHA-256 7850e2987d12e469…
- Counties included in the 2026 Medicare payment localities (26LOCCO)Version CY2026 (RVU26D) · effective 2026-01-01 · file 26LOCCO.txtSHA-256 c1e3a394d641a207…
- CY2026 anesthesia conversion factors by Medicare localityVersion CY2026 (RVU26D) · effective 2026-01-01 · file ANES2026.csvSHA-256 c4d61aa421069986…
- ZIP code to carrier locality file (ZIP5), October 2026Version ZIP5 October 2026 (file updated 2026-08-13) · effective 2026-10-01 · file ZIP5_OCT2026.txtSHA-256 6892be209ade4324…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- DMEPOS fee schedule DME26-D, October 2026Version DME26-D (October 2026) · effective 2026-10-01 · file DMEPOS_OCT.csvSHA-256 a2824d58aadf4004…
- DMEPOS rural ZIP code file, quarter 4 2026Version Q4 2026 · effective 2026-10-01 · file DME Rural Zip Code Quarter 4 2026.csvSHA-256 226616fbcbc4ace5…
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.