TL;DR
Virginia is a single Medicare payment locality (11302-00, contractor 11302). Its 2026 indices are 1.000 for work, 0.983 for practice expense and 0.706 for malpractice, a geographic adjustment factor of 0.980 (-2.0% against the national 1.000, rank 75 of 109). In an office, 99213 pays $93.48 here against $95.19 nationally, G2211 $17.08 against $17.37 and G0439 $135.16 against $137.61. The locality takes in All Counties, except Alexandria City, Arlington, Fairfax, Fairfax City, and Falls Church City, 1,145 ZIP codes in the October 2026 file.
Locality 11302-00 at a glance
- Contractor and locality
- 11302-00
- Palmetto GBA
- Geographic adjustment factor
- 0.980
- -2.0% vs national, rank 75 of 109
- Anesthesia conversion factor
- $20.05
- QP $20.15; national $20.50
- ZIP codes
- 1,145
- 416 rural, 63 super rural
- DMEPOS rural ZIP codes
- 426
- on the quarter 4 2026 list
2026 GPCIs for Virginia
| Component | GPCI | vs national 1.000 |
|---|---|---|
| Work (physician time and effort) | 1.000 | +0.0% |
| Practice expense (staff, rent, equipment, supplies) | 0.983 | -1.7% |
| Malpractice (professional liability insurance) | 0.706 | -29.4% |
| Geographic adjustment factor (weighted) | 0.980 | -2.0% |
A fee schedule amount here is [(work RVU x 1.000) + (practice expense RVU x 0.983) + (malpractice RVU x 0.706)] 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 Virginia
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 | $93.48 | $95.19 | $56.38 | -1.8% |
| 99214CPT number | $133.10 | $135.61 | $82.86 | -1.9% |
| G2211 | $17.08 | $17.37 | $14.12 | -1.7% |
| G0439 | $135.16 | $137.61 | $135.16 | -1.8% |
| G0402 | $171.62 | $174.69 | $112.19 | -1.8% |
| 20610CPT number | $66.87 | $68.81 | $38.31 | -2.8% |
Counties and ZIP codes in locality 11302-00
The CMS locality file defines Virginia as All Counties, except Alexandria City, Arlington, Fairfax, Fairfax City, and Falls Church City. The October 2026 ZIP code file assigns 1,145 ZIP codes to it; 416 are flagged rural and 63 super rural for physician fee schedule purposes, and 1 are split by ZIP+4, so for an address in one of those the ZIP+4 file decides the locality.
| ZIP prefix | ZIP codes |
|---|---|
| 003xx | 4 |
| 201xx | 67 |
| 205xx | 1 |
| 220xx | 4 |
| 221xx | 9 |
| 224xx | 38 |
| 225xx | 45 |
| 226xx | 34 |
| 227xx | 38 |
| 228xx | 31 |
| 229xx | 52 |
| 230xx | 59 |
| 231xx | 63 |
| 232xx | 54 |
| 233xx | 38 |
| 234xx | 64 |
| 235xx | 26 |
| 236xx | 33 |
| 237xx | 8 |
| 238xx | 60 |
| 239xx | 39 |
| 240xx | 81 |
| 241xx | 53 |
| 242xx | 52 |
| 243xx | 42 |
| 244xx | 49 |
| 245xx | 67 |
| 246xx | 34 |
Every ZIP code in locality 11302-00 (357 ranges)
00303-00304, 00323, 00353, 20101-20113, 20115-20119, 20128-20132, 20134-20144, 20146-20149, 20152, 20155-20156, 20158-20160, 20163-20169, 20175-20178, 20180-20182, 20184-20189, 20197-20199, 20598, 22002, 22025-22026, 22093, 22125, 22134-22135, 22172, 22191-22195, 22401-22408, 22412, 22427-22428, 22430, 22432-22433, 22435-22438, 22442-22443, 22446, 22448, 22451, 22454, 22456, 22460-22461, 22463, 22469, 22471-22473, 22476, 22480-22482, 22485, 22488, 22501, 22503-22504, 22507-22509, 22511, 22513-22514, 22517, 22520, 22523-22524, 22526, 22528-22530, 22534-22535, 22538-22539, 22542, 22544-22548, 22551-22556, 22558, 22560, 22565, 22567, 22570, 22572, 22576-22581, 22601-22604, 22610-22611, 22620, 22622-22627, 22630, 22637-22646, 22649-22650, 22652, 22654-22657, 22660, 22663-22664, 22701, 22709, 22711-22716, 22718-22743, 22746-22749, 22801-22803, 22807, 22810-22812, 22815, 22820-22821, 22824, 22827, 22830-22835, 22840-22851, 22853, 22901-22911, 22920, 22922-22924, 22929, 22931-22932, 22935-22940, 22942-22943, 22945-22949, 22952-22954, 22957-22960, 22963-22965, 22967-22969, 22971-22974, 22976, 22980, 22987, 22989, 23001-23005, 23009, 23011, 23014-23015, 23017-23018, 23021-23025, 23027, 23030-23032, 23035, 23038-23040, 23043, 23045, 23047, 23050, 23054-23056, 23058-23072, 23075-23076, 23079, 23081, 23083-23086, 23089-23093, 23101-23103, 23105-23117, 23119-23120, 23123-23131, 23138-23141, 23146-23150, 23153-23156, 23160-23163, 23168-23170, 23173, 23175-23178, 23180-23181, 23183-23188, 23190-23192, 23218-23238, 23240-23242, 23249-23250, 23255, 23260-23261, 23266, 23269-23270, 23272-23276, 23278-23280, 23282, 23284-23286, 23288-23295, 23297-23298, 23301-23304, 23306-23308, 23310, 23313-23316, 23320-23328, 23336-23337, 23341, 23345, 23347, 23350, 23354, 23356-23359, 23389, 23395-23399, 23401, 23404-23405, 23407-23410, 23412-23424, 23426-23427, 23429-23443, 23450-23468, 23471, 23479-23480, 23482-23483, 23486-23488, 23500-23515, 23517-23521, 23523, 23529-23530, 23541, 23551, 23600-23609, 23612, 23628, 23630-23631, 23651, 23653, 23661-23670, 23681, 23690-23694, 23696, 23701-23705, 23707-23709, 23801, 23803-23806, 23821-23822, 23824-23825, 23827-23834, 23836-23847, 23850-23851, 23856-23857, 23860, 23866-23868, 23870, 23872-23876, 23878-23879, 23881-23885, 23887-23891, 23893-23894, 23897-23899, 23901, 23909, 23911, 23915, 23917, 23919-23924, 23927, 23930, 23934, 23936-23939, 23941-23944, 23947, 23950, 23952, 23954-23955, 23958-23960, 23962-23964, 23966-23968, 23970, 23974, 23976, 24000-24020, 24022-24038, 24040, 24042-24045, 24048, 24050, 24053-24055, 24058-24070, 24072-24073, 24076-24079, 24082-24095, 24101-24102, 24104-24105, 24111-24115, 24120-24122, 24124, 24126-24134, 24136-24139, 24141-24143, 24146-24151, 24153, 24155-24157, 24161-24162, 24165, 24167-24168, 24171, 24174-24179, 24184-24185, 24201-24203, 24205, 24209-24212, 24215-24221, 24224-24226, 24228, 24230, 24236-24237, 24239, 24243-24246, 24248, 24250-24251, 24256, 24258, 24260, 24263, 24265-24266, 24269-24273, 24277, 24279-24283, 24285, 24289-24290, 24292-24293, 24301, 24311-24319, 24322-24328, 24330, 24333, 24340, 24343, 24347-24348, 24350-24352, 24354, 24360-24361, 24363, 24366, 24368, 24370, 24373-24375, 24377-24382, 24401-24402, 24407, 24411-24413, 24415-24416, 24421-24422, 24426, 24430-24433, 24435, 24437-24442, 24445, 24448, 24450, 24457-24460, 24463-24465, 24467-24469, 24471-24477, 24479, 24482-24487, 24501-24506, 24512-24515, 24517, 24520-24523, 24526-24531, 24533-24536, 24538-24541, 24543-24544, 24549-24551, 24553-24558, 24562-24563, 24565-24566, 24569-24572, 24574, 24576-24581, 24585-24586, 24588-24590, 24592-24595, 24597-24599, 24601-24609, 24612-24614, 24618-24620, 24622, 24624, 24627-24628, 24630-24631, 24634-24635, 24637, 24639-24641, 24646-24647, 24649, 24651, 24656-24658
Localities with a similar adjustment
Ranked by geographic adjustment factor, the localities on either side of Virginia are Arizona, AZ (0.980) and Southern Maine, ME (0.980). 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 Virginia
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 Virginia 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 | $51.94 | $91.49 | $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 | $78.16 | $128.14 | $72.80 to $78.16 |
| K0001-RR | Standard wheelchaircapped rental, monthly rental | $31.07 | $53.64 | $25.23 to $31.07 |
| E0143-NU | Walker, folding, wheeled, adjustable or fixed heightinexpensive or routinely purchased, purchased new | $60.89 | $101.13 | $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 | $59.09 | — | $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 | $556.31 | $684.50 | $455.16 to $556.31 |
| E0784-RR | External ambulatory infusion pump, insulincapped rental, monthly rental | $557.75 | $576.36 | $557.75 in every state |
Contractor, coverage and other payment systems
Part B claims in this locality are processed by Palmetto GBA, 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 Virginia page covers the state's payers and revenue-cycle requirements.
Where QuickIntell fits for Virginia 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 Virginia?
Work 1.000, practice expense 0.983 and malpractice 0.706 for locality 11302-00, a geographic adjustment factor of 0.980. The work index sits on the 1.0 floor that Congress extended through January 1, 2027.
How much does Medicare pay for 99213 in Virginia?
$93.48 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 11302-00?
1,145 ZIP codes in the October 2026 CMS ZIP file, in the prefixes 003, 201, 205, 220, 221, 224, 225, 226, 227, 228, 229 and 230 and others. 416 are rural and 63 super rural in that file.
Who processes Part B claims for Virginia?
Palmetto GBA, under contractor number 11302. 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.