ADDENDUM D. UPDATED CY 2020 GEOGRAPHIC ADJUSTMENT FACTORS (GAFs)*							
Carrier	State	Locality Number	Medicare Locality	2020 GAF (with 1.0 Work Floor)*	2020 GAF (without 1.0 Work Floor)*		
10112	AL	00	ALABAMA	0.938	0.930		
02102	AK	01	ALASKA**	1.293	1.293		
03102	AZ	00	ARIZONA	0.976	0.971		
07102	AR	13	ARKANSAS	0.916	0.904		
01112	CA	54	BAKERSFIELD	1.034	1.034		
01112	CA	55	CHICO	1.025	1.025		
01182	CA	71	EL CENTRO	1.027	1.027		
01112	CA	56	FRESNO	1.025	1.025		
01112	CA	57	HANFORD-CORCORAN	1.025	1.025		
01182	CA	18	LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY)	1.091	1.091		
01182	CA	26	LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY)	1.091	1.091		
01112	CA	58	MADERA	1.025	1.025		
01112	CA	59	MERCED	1.025	1.025		
01112	CA	60	MODESTO	1.025	1.025		
01112	CA	51	NAPA	1.110	1.110		
01112	CA	07	SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY)	1.161	1.161		
01182	CA	17	OXNARD-THOUSAND OAKS-VENTURA	1.080	1.080		
01112	CA	61	REDDING	1.025	1.025		
01112	CA	62	RIVERSIDE-SAN BERNARDINO-ONTARIO	1.036	1.036		
01112	CA	63	SACRAMENTO--ROSEVILLE--ARDEN-ARCADE	1.034	1.034		
01112	CA	64	SALINAS	1.058	1.058		
01182	CA	72	SAN DIEGO-CARLSBAD	1.058	1.058		
01112	CA	05	SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY)	1.161	1.161		
01112	CA	52	SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY)	1.146	1.146		
01112	CA	65	SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY)	1.143	1.143		
01182	CA	73	SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE	1.031	1.031		
01112	CA	06	SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY)	1.161	1.161		
01112	CA	09	SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY)	1.185	1.185		
01112	CA	66	SANTA CRUZ-WATSONVILLE	1.073	1.073		
01182	CA	74	SANTA MARIA-SANTA BARBARA	1.063	1.063		
01112	CA	67	SANTA ROSA	1.065	1.065		
01112	CA	68	STOCKTON-LODI	1.026	1.026		
01112	CA	53	VALLEJO-FAIRFIELD	1.110	1.110		
01112	CA	69	VISALIA-PORTERVILLE	1.025	1.025		
01112	CA	70	YUBA CITY	1.025	1.025		
01112	CA	75	REST OF CALIFORNIA	1.025	1.025		
04112	CO	01	COLORADO	1.011	1.011		
13102	CT	00	CONNECTICUT	1.069	1.069		
12202	DC	01	DC + MD/VA SUBURBS	1.136	1.136		
12102	DE	01	DELAWARE	1.013	1.013		
09102	FL	03	FORT LAUDERDALE	1.038	1.033		
09102	FL	04	MIAMI	1.080	1.076		
09102	FL	99	REST OF FLORIDA	0.993	0.985		
10212	GA	01	ATLANTA	0.999	0.999		
10212	GA	99	REST OF GEORGIA	0.950	0.943		
01212	HI	01	"HAWAII, GUAM"	1.052	1.052		
02202	ID	00	IDAHO	0.927	0.916		
06102	IL	16	CHICAGO	1.061	1.061		
06102	IL	12	EAST ST. LOUIS	1.004	1.000		
06102	IL	15	SUBURBAN CHICAGO	1.053	1.053		
06102	IL	99	REST OF ILLINOIS	0.971	0.964		
08102	IN	00	INDIANA	0.935	0.925		
05102	IA	00	IOWA	0.934	0.926		
05202	KS	00	KANSAS	0.940	0.930		
15102	KY	00	KENTUCKY	0.936	0.928		
07202	LA	01	NEW ORLEANS	0.993	0.987		
07202	LA	99	REST OF LOUISIANA	0.957	0.947		
14112	ME	03	SOUTHERN MAINE	0.986	0.984		
14112	ME	99	REST OF MAINE	0.945	0.936		
12302	MD	01	BALTIMORE/SURR. CNTYS	1.069	1.069		
12302	MD	99	REST OF MARYLAND	1.024	1.024		
14212	MA	01	METROPOLITAN BOSTON	1.104	1.104		
14212	MA	99	REST OF MASSACHUSETTS	1.038	1.038		
08202	MI	01	DETROIT	1.025	1.022		
08202	MI	99	REST OF MICHIGAN	0.962	0.955		
06202	MN	00	MINNESOTA	0.978	0.978		
07302	MS	00	MISSISSIPPI	0.915	0.904		
05302	MO	02	METROPOLITAN KANSAS CITY	0.981	0.976		
05302	MO	01	METROPOLITAN ST. LOUIS	0.984	0.981		
05302	MO	99	REST OF MISSOURI	0.932	0.921		
03202	MT	01	MONTANA***	1.013	1.000		
05402	NE	00	NEBRASKA	0.928	0.921		
01312	NV	00	NEVADA***	1.007	1.007		
14312	NH	40	NEW HAMPSHIRE	1.018	1.018		
12402	NJ	01	NORTHERN NJ	1.106	1.106		
12402	NJ	99	REST OF NEW JERSEY	1.072	1.072		
04212	NM	05	NEW MEXICO	0.968	0.963		
13202	NY	01	MANHATTAN	1.149	1.149		
13202	NY	02	NYC SUBURBS/LONG ISLAND	1.179	1.179		
13202	NY	03	POUGHKPSIE/N NYC SUBURBS	1.071	1.071		
13292	NY	04	QUEENS	1.183	1.183		
13282	NY	99	REST OF NEW YORK	0.965	0.962		
11502	NC	00	NORTH CAROLINA	0.958	0.952		
03302	ND	01	NORTH DAKOTA***	0.978	0.970		
15202	OH	00	OHIO	0.964	0.960		
04312	OK	00	OKLAHOMA	0.943	0.933		
02302	OR	01	PORTLAND	1.020	1.020		
02302	OR	99	REST OF OREGON	0.966	0.962		
12502	PA	01	METROPOLITAN PHILADELPHIA	1.059	1.059		
12502	PA	99	REST OF PENNSYLVANIA	0.970	0.967		
09202	PR	20	PUERTO RICO	1.003	1.002		
14412	RI	01	RHODE ISLAND	1.034	1.034		
11202	SC	01	SOUTH CAROLINA	0.942	0.935		
03402	SD	02	SOUTH DAKOTA***	0.973	0.960		
10312	TN	35	TENNESSEE	0.933	0.925		
04412	TX	31	AUSTIN	1.003	1.003		
04412	TX	20	BEAUMONT	0.957	0.954		
04412	TX	09	BRAZORIA	1.004	1.004		
04412	TX	11	DALLAS	1.003	1.003		
04412	TX	28	FORT WORTH	0.986	0.986		
04412	TX	15	GALVESTON	1.008	1.008		
04412	TX	18	HOUSTON	1.019	1.019		
04412	TX	99	REST OF TEXAS	0.963	0.961		
03502	UT	09	UTAH	0.965	0.957		
14512	VT	50	VERMONT	0.986	0.981		
11302	VA	00	VIRGINIA	0.992	0.991		
09202	VI	50	VIRGIN ISLANDS	1.003	1.002		
02402	WA	02	SEATTLE (KING CNTY)	1.086	1.086		
02402	WA	99	REST OF WASHINGTON	0.998	0.998		
11402	WV	16	WEST VIRGINIA	0.947	0.937		
06302	WI	00	WISCONSIN	0.948	0.943		
03602	WY	21	WYOMING***	0.994	0.986		
"MAC assignments as of December 19, 2019"							
							
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 2201 of the Continuing Appropriations Act, 2021 and Other Extensions Act [October 1, 2020] extended the Work GPCI floor through December 18, 2020 only."							
