Medicare payment locality · Q3 2026 release
San Jose-Sunnyvale-Santa Clara (San Benito County) CA
MAC 01112 · Locality 65This locality's GPCIs lift Medicare payments above the national average for the Q3 2026 Physician Fee Schedule. Every code below is the national amount rescaled by the three local indexes.
1.000 is the national baseline. Above raises that component; below lowers it.
Example rates in San Jose-Sunnyvale-Santa Clara (San Benito County)
National vs. San Jose-Sunnyvale-Santa Clara (San Benito County) non-facility amounts for common codes, Q3 2026 (before sequestration).
| Code | National | San Jose-Sunnyvale-Santa Clara (San Benito County) | Difference |
|---|---|---|---|
| 0446T | $6,320.12 | $9,098.58 | +44.0% |
| 0447T | $100.87 | $128.51 | +27.4% |
| 0448T | $6,219.58 | $8,942.87 | +43.8% |
| 0509T | $77.82 | $107.29 | +37.9% |
| 0583T | $1,505.04 | $2,136.27 | +41.9% |
| 0596T | $2,019.08 | $2,880.70 | +42.7% |
| 0597T | $596.54 | $847.08 | +42.0% |
| 0605T | $758.53 | $1,091.69 | +43.9% |
| 10004 | $53.11 | $64.00 | +20.5% |
| 10005 | $132.27 | $169.84 | +28.4% |
Need a specific code or a facility rate? Use the rate calculator with this locality selected.
ZIP codes in this locality
San Jose-Sunnyvale-Santa Clara (San Benito County) covers 6 ZIP codes across CA, per the CMS ZIP-to-locality crosswalk (Q3 2026). 1 of them span more than one locality and need ZIP+4 for an exact match.
Not sure which locality your ZIP is in? Look it up by ZIP code.
Common questions
Why do Medicare rates in San Jose-Sunnyvale-Santa Clara (San Benito County) differ from the national amount?
Medicare scales each code's work, practice-expense, and malpractice RVUs by this locality's three GPCIs before applying the conversion factor, so local labor, rent, and liability costs move the final amount up or down. San Jose-Sunnyvale-Santa Clara (San Benito County) currently pays above the national average for the Q3 2026 release.
How do I know if my address is in this locality?
Medicare assigns localities by ZIP code, not city or county lines, so neighboring addresses can fall in different localities. Look up your ZIP to find your locality. About 1 ZIP codes in San Jose-Sunnyvale-Santa Clara (San Benito County) span more than one locality and need the ZIP+4 to resolve exactly.
Do commercial insurers or Medicare Advantage plans use this locality?
No. Medicare payment localities are specific to Original Medicare's Physician Fee Schedule. Medicare Advantage plans and commercial insurers set their own geographic adjustments and negotiated network rates — they aren't required to follow CMS locality boundaries, even though many benchmark off the Medicare amount.
Does my locality affect what I owe as a patient?
Yes. Your 20% coinsurance under Original Medicare is calculated on the locality-adjusted amount, not the national one, so the same code can leave you owing more or less depending on where you're treated. San Jose-Sunnyvale-Santa Clara (San Benito County) pays above the national average, so patients here typically owe a bit more in coinsurance than the national amount would suggest.
Why did my Medicare payment change even though I didn't change what I billed?
GPCIs and the conversion factor update with each quarterly CMS release (January, April, July, October), so the same code in the same locality can pay a different amount quarter to quarter with nothing else changing — see what changed each release.
Source & method
GPCIs and rates computed from the CMS Medicare Physician Fee Schedule Q3 2026 release (effective July 2026). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release. Example amounts are national non-facility figures rescaled by this locality's GPCIs, before the ~2% sequestration cut. Releases are immutable; a rate retrieved for a past quarter always reflects that release.
Spot an inaccuracy?
We work hard to keep every rate and citation accurate, but CMS source data is messy and mistakes happen. If something here looks wrong, we'd appreciate you letting us know.
Report an inaccuracy