ADDENDUM D. FINAL CY 2021 GEOGRAPHIC ADJUSTMENT FACTORS (GAFs) BY STATE AND MEDICARE LOCALITY				
"For the purposes of the PFS, GAFs are an analysis tool for comparing approximate aggregate geographic payment adjustment among PFS localities "				
Medicare Adminstrative Contractor	State	Locality Number	Locality Name	2021 GAF (with 1.0 Work Floor)
10112	AL	00	ALABAMA	0.946
02102	AK	01	ALASKA*	1.291
03102	AZ	00	ARIZONA	0.972
07102	AR	13	ARKANSAS	0.908
01112	CA	54	BAKERSFIELD	1.034
01112	CA	55	CHICO	1.026
01182	CA	71	EL CENTRO	1.027
01112	CA	56	FRESNO	1.026
01112	CA	57	HANFORD-CORCORAN	1.026
01182	CA	18	LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY)	1.092
01182	CA	26	LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY)	1.092
01112	CA	58	MADERA	1.026
01112	CA	59	MERCED	1.026
01112	CA	60	MODESTO	1.026
01112	CA	51	NAPA	1.100
01112	CA	07	SAN FRANCISCO-OAKLAND-BERKELEY (ALAMEDA/CONTRA COSTA CNTY)	1.163
01182	CA	17	OXNARD-THOUSAND OAKS-VENTURA	1.082
01112	CA	61	REDDING	1.026
01112	CA	62	RIVERSIDE-SAN BERNARDINO-ONTARIO	1.039
01112	CA	63	SACRAMENTO-ROSEVILLE-FOLSOM	1.036
01112	CA	64	SALINAS	1.067
01182	CA	72	SAN DIEGO-CHULA VISTA-CARLSBAD	1.066
01112	CA	05	SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO CNTY)	1.163
01112	CA	52	SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY)	1.154
01112	CA	65	SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY)	1.174
01182	CA	73	SAN LUIS OBISPO-PASO ROBLES	1.035
01112	CA	06	SAN FRANCISCO-OAKLAND-BERKELEY (SAN MATEO CNTY)	1.163
01112	CA	09	SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY)	1.195
01112	CA	66	SANTA CRUZ-WATSONVILLE	1.086
01182	CA	74	SANTA MARIA-SANTA BARBARA	1.073
01112	CA	67	SANTA ROSA-PETALUMA	1.075
01112	CA	68	STOCKTON	1.026
01112	CA	53	VALLEJO	1.100
01112	CA	69	VISALIA	1.026
01112	CA	70	YUBA CITY	1.026
01112	CA	75	REST OF CALIFORNIA	1.026
04112	CO	01	COLORADO	1.011
13102	CT	00	CONNECTICUT	1.067
12202	DC	01	DC + MD/VA SUBURBS	1.146
12102	DE	01	DELAWARE	1.009
09102	FL	03	FORT LAUDERDALE	1.037
09102	FL	04	MIAMI	1.080
09102	FL	99	REST OF FLORIDA	0.991
10212	GA	01	ATLANTA	0.995
10212	GA	99	REST OF GEORGIA	0.941
01212	HI	01	"HAWAII, GUAM"	1.055
02202	ID	00	IDAHO	0.920
06102	IL	16	CHICAGO	1.062
06102	IL	12	EAST ST. LOUIS	1.002
06102	IL	15	SUBURBAN CHICAGO	1.053
06102	IL	99	REST OF ILLINOIS	0.968
08102	IN	00	INDIANA	0.932
05102	IA	00	IOWA	0.934
05202	KS	00	KANSAS	0.935
15102	KY	00	KENTUCKY	0.934
07202	LA	01	NEW ORLEANS	0.990
07202	LA	99	REST OF LOUISIANA	0.956
14112	ME	03	SOUTHERN MAINE	0.984
14112	ME	99	REST OF MAINE	0.939
12302	MD	01	BALTIMORE/SURR. CNTYS	1.071
12302	MD	99	REST OF MARYLAND	1.025
14212	MA	01	METROPOLITAN BOSTON	1.109
14212	MA	99	REST OF MASSACHUSETTS	1.034
08202	MI	01	DETROIT	1.025
08202	MI	99	REST OF MICHIGAN	0.959
06202	MN	00	MINNESOTA	0.978
07302	MS	00	MISSISSIPPI	0.915
05302	MO	02	METROPOLITAN KANSAS CITY	0.975
05302	MO	01	METROPOLITAN ST. LOUIS	0.984
05302	MO	99	REST OF MISSOURI	0.926
03202	MT	01	MONTANA**	0.999
05402	NE	00	NEBRASKA	0.926
01312	NV	00	NEVADA**	1.018
14312	NH	40	NEW HAMPSHIRE	1.013
12402	NJ	01	NORTHERN NJ	1.113
12402	NJ	99	REST OF NEW JERSEY	1.080
04212	NM	05	NEW MEXICO	0.960
13202	NY	01	MANHATTAN	1.164
13202	NY	02	NYC SUBURBS/LONG ISLAND	1.196
13202	NY	03	POUGHKPSIE/N NYC SUBURBS	1.089
13292	NY	04	QUEENS	1.202
13282	NY	99	REST OF NEW YORK	0.969
11502	NC	00	NORTH CAROLINA	0.960
03302	ND	01	NORTH DAKOTA**	0.976
15202	OH	00	OHIO	0.965
04312	OK	00	OKLAHOMA	0.937
02302	OR	01	PORTLAND	1.020
02302	OR	99	REST OF OREGON	0.956
12502	PA	01	METROPOLITAN PHILADELPHIA	1.057
12502	PA	99	REST OF PENNSYLVANIA	0.968
09202	PR	20	PUERTO RICO	1.003
14412	RI	01	RHODE ISLAND	1.031
11202	SC	01	SOUTH CAROLINA	0.943
03402	SD	02	SOUTH DAKOTA**	0.972
10312	TN	35	TENNESSEE	0.930
04412	TX	31	AUSTIN	1.007
04412	TX	20	BEAUMONT	0.956
04412	TX	09	BRAZORIA	1.007
04412	TX	11	DALLAS	1.004
04412	TX	28	FORT WORTH	0.986
04412	TX	15	GALVESTON	1.009
04412	TX	18	HOUSTON	1.025
04412	TX	99	REST OF TEXAS	0.962
03502	UT	09	UTAH	0.955
14512	VT	50	VERMONT	0.982
11302	VA	00	VIRGINIA	0.993
09202	VI	50	VIRGIN ISLANDS	1.003
02402	WA	02	SEATTLE (KING CNTY)	1.096
02402	WA	99	REST OF WASHINGTON	0.995
11402	WV	16	WEST VIRGINIA	0.945
06302	WI	00	WISCONSIN	0.944
03602	WY	21	WYOMING**	0.993
"MAC Assignments as of October 27, 2020"				
				
GAF equation: (0.50866 * work GPCI) + (0.44839 * PE GPCI) + (0.04295 * MP GPCI).				
				
*GAF reflects a 1.5 work GPCI floor in Alaska established by the MIPPA.				
**GAF reflects a 1.0 PE GPCI floor for frontier states established by the Affordable Care Act.				
				
"Note:   The 1.0 Work GPCI floor required by Section 101 of the Consolidated Appropriations Act, 2021 [December 27, 2020] extended the Work GPCI floor through January 1, 2024."				
				
"Note:  Starting for CY 2021, the locality names in California are updated to reflect the revised delineations of Metropolitan Statistical Areas as indicated in OMB Bulletin No. 20-01 (March 6, 2020)."				
            A detailed discussion of the requirement to use MSAs for the fee schedule areas in California can be found in the CY 2017 PFS Final Rule (81 FR 80265).				
				
