ADDENDUM D. PROPOSED CY 2026 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 Administrative Contractor (MAC)	State	Locality Number	Locality Name	2025 GAF (with 1.0 Work Floor)	2026 GAF (without 1.0 Work Floor)	"Percent Change
(2025-2026)"	
10112	AL	00	ALABAMA	0.923	0.919	-0.4%	
02102	AK	01	ALASKA*	1.271	1.261	-0.8%	
03102	AZ	00	ARIZONA	0.983	0.975	-0.8%	
07102	AR	13	ARKANSAS	0.916	0.902	-1.5%	
01112	CA	54	BAKERSFIELD	1.037	1.038	0.1%	
01112	CA	55	CHICO	1.031	1.034	0.3%	
01182	CA	71	EL CENTRO	1.032	1.034	0.2%	
01112	CA	56	FRESNO	1.031	1.034	0.3%	
01112	CA	57	HANFORD-CORCORAN	1.031	1.034	0.3%	
01182	CA	18	LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY)	1.097	1.091	-0.5%	
01112	CA	58	MADERA	1.031	1.034	0.3%	
01112	CA	59	MERCED	1.031	1.034	0.3%	
01112	CA	60	MODESTO	1.031	1.034	0.3%	
01112	CA	51	NAPA	1.151	1.158	0.6%	
01182	CA	17	OXNARD-THOUSAND OAKS-VENTURA	1.082	1.083	0.1%	
01112	CA	61	REDDING	1.031	1.034	0.3%	
01112	CA	62	RIVERSIDE-SAN BERNARDINO-ONTARIO	1.045	1.047	0.2%	
01112	CA	63	SACRAMENTO-ROSEVILLE-FOLSOM	1.070	1.075	0.5%	
01112	CA	64	SALINAS	1.075	1.070	-0.5%	
01182	CA	72	SAN DIEGO-CHULA VISTA-CARLSBAD	1.083	1.087	0.4%	
01112	CA	05	SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY)	1.212	1.214	0.2%	
01112	CA	52	SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY)	1.213	1.215	0.2%	
01112	CA	65	SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY)	1.230	1.240	0.8%	
01182	CA	73	SAN LUIS OBISPO-PASO ROBLES	1.049	1.054	0.5%	
01112	CA	09	SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY)	1.224	1.235	0.9%	
01112	CA	66	SANTA CRUZ-WATSONVILLE	1.085	1.091	0.6%	
01182	CA	74	SANTA MARIA-SANTA BARBARA	1.072	1.072	0.0%	
01112	CA	67	SANTA ROSA-PETALUMA	1.101	1.102	0.1%	
01112	CA	68	STOCKTON	1.031	1.034	0.3%	
01112	CA	53	VALLEJO	1.149	1.157	0.7%	
01112	CA	69	VISALIA	1.031	1.034	0.3%	
01112	CA	70	YUBA CITY	1.031	1.034	0.3%	
01112	CA	75	REST OF CALIFORNIA	1.031	1.034	0.3%	
04112	CO	01	COLORADO	1.021	1.027	0.6%	
13102	CT	00	CONNECTICUT	1.062	1.054	-0.8%	
12202	DC	01	DC + MD/VA SUBURBS	1.123	1.114	-0.8%	
12102	DE	01	DELAWARE	0.999	0.993	-0.6%	
09102	FL	03	FORT LAUDERDALE	1.031	1.035	0.4%	
09102	FL	04	MIAMI	1.075	1.078	0.3%	
09102	FL	99	REST OF FLORIDA	0.992	0.994	0.2%	
10212	GA	01	ATLANTA	1.004	1.017	1.3%	
10212	GA	99	REST OF GEORGIA	0.952	0.951	-0.1%	
01212	HI	01	"HAWAII, GUAM"	1.050	1.045	-0.5%	
02202	ID	00	IDAHO	0.936	0.932	-0.4%	
06102	IL	16	CHICAGO	1.056	1.058	0.2%	
06102	IL	12	EAST ST. LOUIS	0.996	0.998	0.2%	
06102	IL	15	SUBURBAN CHICAGO	1.048	1.047	-0.1%	
06102	IL	99	REST OF ILLINOIS	0.976	0.977	0.1%	
08102	IN	00	INDIANA	0.943	0.940	-0.3%	
05102	IA	00	IOWA	0.938	0.928	-1.1%	
05202	KS	00	KANSAS	0.938	0.928	-1.1%	
15102	KY	00	KENTUCKY	0.940	0.936	-0.4%	
07202	LA	01	NEW ORLEANS	0.977	0.973	-0.4%	
07202	LA	99	REST OF LOUISIANA	0.945	0.938	-0.7%	
14112	ME	03	SOUTHERN MAINE	0.991	0.976	-1.5%	
14112	ME	99	REST OF MAINE	0.946	0.940	-0.6%	
12302	MD	01	BALTIMORE/SURR. CNTYS	1.058	1.051	-0.7%	
12302	MD	99	REST OF MARYLAND	1.012	1.007	-0.5%	
14212	MA	01	METROPOLITAN BOSTON	1.106	1.106	0.0%	
14212	MA	99	REST OF MASSACHUSETTS	1.028	1.024	-0.4%	
08202	MI	01	DETROIT	1.025	1.010	-1.5%	
08202	MI	99	REST OF MICHIGAN	0.967	0.958	-0.9%	
06202	MN	00	MINNESOTA	0.982	0.985	0.3%	
07302	MS	00	MISSISSIPPI	0.923	0.912	-1.2%	
05302	MO	02	METROPOLITAN KANSAS CITY	0.976	0.965	-1.1%	
05302	MO	01	METROPOLITAN ST. LOUIS	0.978	0.972	-0.6%	
05302	MO	99	REST OF MISSOURI	0.935	0.923	-1.3%	
03202	MT	01	MONTANA**	0.999	0.992	-0.7%	
05402	NE	00	NEBRASKA	0.933	0.931	-0.2%	
01312	NV	00	NEVADA**	0.994	0.988	-0.6%	
14312	NH	40	NEW HAMPSHIRE	1.011	1.012	0.1%	
12402	NJ	01	NORTHERN NJ	1.112	1.108	-0.4%	
12402	NJ	99	REST OF NEW JERSEY	1.072	1.066	-0.6%	
04212	NM	05	NEW MEXICO	0.965	0.965	0.0%	
13202	NY	01	MANHATTAN	1.136	1.130	-0.5%	
13202	NY	02	NYC SUBURBS/LONG ISLAND	1.162	1.154	-0.7%	
13202	NY	03	POUGHKPSIE/N NYC SUBURBS	1.082	1.075	-0.6%	
13292	NY	04	QUEENS	1.141	1.134	-0.6%	
13282	NY	99	REST OF NEW YORK	0.966	0.962	-0.4%	
11502	NC	00	NORTH CAROLINA	0.952	0.950	-0.2%	
03302	ND	01	NORTH DAKOTA**	0.980	0.970	-1.0%	
15202	OH	00	OHIO	0.961	0.955	-0.6%	
04312	OK	00	OKLAHOMA	0.942	0.933	-1.0%	
02302	OR	01	PORTLAND	1.041	1.049	0.8%	
02302	OR	99	REST OF OREGON	0.979	0.982	0.3%	
12502	PA	01	METROPOLITAN PHILADELPHIA	1.043	1.036	-0.7%	
12502	PA	99	REST OF PENNSYLVANIA	0.964	0.955	-0.9%	
09202	PR	20	PUERTO RICO	1.002	1.004	0.2%	
14412	RI	01	RHODE ISLAND	1.024	1.020	-0.4%	
11202	SC	01	SOUTH CAROLINA	0.953	0.952	-0.1%	
03402	SD	02	SOUTH DAKOTA**	0.974	0.968	-0.6%	
10312	TN	35	TENNESSEE	0.933	0.931	-0.2%	
04412	TX	31	AUSTIN	1.018	1.023	0.5%	
04412	TX	20	BEAUMONT	0.954	0.950	-0.4%	
04412	TX	09	BRAZORIA	1.001	0.991	-1.0%	
04412	TX	11	DALLAS	1.004	0.997	-0.7%	
04412	TX	28	FORT WORTH	1.000	0.993	-0.7%	
04412	TX	15	GALVESTON	1.001	0.994	-0.7%	
04412	TX	18	HOUSTON	1.026	1.016	-1.0%	
04412	TX	99	REST OF TEXAS	0.972	0.968	-0.4%	
03502	UT	09	UTAH	0.967	0.961	-0.6%	
14512	VT	50	VERMONT	0.977	0.969	-0.8%	
11302	VA	00	VIRGINIA	0.984	0.980	-0.4%	
09202	VI	50	VIRGIN ISLANDS	1.002	1.004	0.2%	
02402	WA	02	SEATTLE (KING CNTY)	1.116	1.122	0.5%	
02402	WA	99	REST OF WASHINGTON	1.014	1.021	0.7%	
11402	WV	16	WEST VIRGINIA	0.951	0.947	-0.4%	
06302	WI	00	WISCONSIN	0.953	0.949	-0.4%	
03602	WY	21	WYOMING**	0.989	0.985	-0.4%	
"MAC Assignments as of November 22, 2023"							
							
GAF equation: (0.49734* work GPCI) + (0.46229* PE GPCI) + (0.04037* MP GPCI).							
Note: In previous updates the weights used to calculate GAF were based on MEI shares published by CMS. 							
"Beginning with the CY2023 update, the weights used to calculate the GAF reflect the share of total RVUs each component (i.e. work, PE, and MP) accounts for, based on actual Medicare utilization. "							
							
*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 WORK GPCI floor of 1.0 that was applied in previous updates was extended only through September 30, 2025 by Section 2206 of Full-Year Continuing Appropriations and Extensions Act, 2025."							
"   Therefore, the Work GAFs for 2025 reflect the 1.0 work GPCI floor, and GAFs for 2026 do not reflect a 1.0 floor."							
							
"Note: For CY 2024 and on, Addendum D will reflect the retirement of 3 California localities, as finalized in the CY 2023 PFS final rule. "							
