ADDENDUM D.  FINAL CY 2019 GEOGRAPHIC ADJUSTMENT FACTORS (GAFs)*																																																								
GAFs are an analysis tool for comparing approximate aggregate geographic payment adjustment among PFS localities 																																																								
Medicare Administrative Contractor	Locality Number	Medicare Locality	GAF																																																					
10112	00	ALABAMA	0.929																																																					
02102	01	ALASKA**	1.294																																																					
03102	00	ARIZONA	0.980																																																					
07102	13	ARKANSAS	0.924																																																					
01112	54	"BAKERSFIELD, CA"	1.027																																																					
01112	55	"CHICO, CA"	1.025																																																					
01182	71	"EL CENTRO, CA"	1.025																																																					
01112	56	"FRESNO, CA"	1.025																																																					
01112	57	"HANFORD-CORCORAN, CA"	1.025																																																					
01182	18	"LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY), CA"	1.090																																																					
01182	26	"LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY), CA"	1.090																																																					
01112	58	"MADERA, CA"	1.025																																																					
01112	59	"MERCED, CA"	1.025																																																					
01112	60	"MODESTO, CA"	1.025																																																					
01112	51	"NAPA, CA"	1.119																																																					
01182	17	"OXNARD-THOUSAND OAKS-VENTURA, CA"	1.077																																																					
01112	61	"REDDING, CA"	1.025																																																					
01112	62	"RIVERSIDE-SAN BERNARDINO-ONTARIO, CA"	1.033																																																					
01112	63	"SACRAMENTO--ROSEVILLE--ARDEN-ARCADE, CA"	1.036																																																					
01112	64	"SALINAS, CA"	1.040																																																					
01182	72	"SAN DIEGO-CARLSBAD, CA"	1.045																																																					
01112	07	"SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY), CA"	1.159																																																					
01112	52	"SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY), CA"	1.140																																																					
01112	05	"SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY), CA"	1.159																																																					
01112	06	"SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY), CA"	1.159																																																					
01112	65	"SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY), CA"	1.104																																																					
01112	09	"SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY), CA"	1.175																																																					
01182	73	"SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE, CA"	1.029																																																					
01112	66	"SANTA CRUZ-WATSONVILLE, CA"	1.069																																																					
01182	74	"SANTA MARIA-SANTA BARBARA, CA"	1.054																																																					
01112	67	"SANTA ROSA, CA"	1.052																																																					
01112	68	"STOCKTON-LODI, CA"	1.025																																																					
01112	53	"VALLEJO-FAIRFIELD, CA"	1.119																																																					
01112	69	"VISALIA-PORTERVILLE, CA"	1.025																																																					
01112	70	"YUBA CITY, CA"	1.025																																																					
01112	75	REST OF CALIFORNIA	1.025																																																					
04112	01	COLORADO	1.010																																																					
13102	00	CONNECTICUT	1.072																																																					
12202	01	DC + MD/VA SUBURBS	1.126																																																					
12102	01	DELAWARE	1.017																																																					
09102	03	"FORT LAUDERDALE, FL"	1.040																																																					
09102	04	"MIAMI, FL"	1.080																																																					
09102	99	REST OF FLORIDA	0.994																																																					
10212	01	"ATLANTA, GA"	1.002																																																					
10212	99	REST OF GEORGIA	0.958																																																					
01212	01	"HAWAII, GUAM"	1.049																																																					
02202	00	IDAHO	0.935																																																					
06102	16	"CHICAGO, IL"	1.059																																																					
06102	12	"EAST ST. LOUIS, IL"	1.005																																																					
06102	15	"SUBURBAN CHICAGO, IL"	1.053																																																					
06102	99	REST OF ILLINOIS	0.973																																																					
08102	00	INDIANA	0.937																																																					
05102	00	IOWA	0.934																																																					
05202	00	KANSAS	0.944																																																					
15102	00	KENTUCKY	0.938																																																					
07202	01	"NEW ORLEANS, LA"	0.996																																																					
07202	99	REST OF LOUISIANA	0.958																																																					
14112	03	SOUTHERN MAINE	0.989																																																					
14112	99	REST OF MAINE	0.951																																																					
12302	01	BALTIMORE/SURR. CNTYS	1.067																																																					
12302	99	REST OF MARYLAND	1.023																																																					
14212	01	"METROPOLITAN BOSTON, MA"	1.100																																																					
14212	99	REST OF MASSACHUSETTS	1.043																																																					
08202	01	"DETROIT, MI"	1.025																																																					
08202	99	REST OF MICHIGAN	0.964																																																					
06202	00	MINNESOTA	0.978																																																					
07302	00	MISSISSIPPI	0.915																																																					
05302	02	"METROPOLITAN KANSAS CITY, MO"	0.987																																																					
05302	01	"METROPOLITAN ST. LOUIS, MO"	0.984																																																					
05302	99	REST OF MISSOURI	0.938																																																					
03202	01	MONTANA***	1.027																																																					
05402	00	NEBRASKA	0.930																																																					
01312	00	NEVADA***	1.005																																																					
14312	40	NEW HAMPSHIRE	1.022																																																					
12402	01	NORTHERN NJ	1.099																																																					
12402	99	REST OF NEW JERSEY	1.065																																																					
04212	05	NEW MEXICO	0.975																																																					
13202	01	"MANHATTAN, NY"	1.134																																																					
13202	02	"NYC SUBURBS/LONG ISLAND, NY"	1.162																																																					
13202	03	"POUGHKPSIE/N NYC SUBURBS, NY"	1.053																																																					
13292	04	"QUEENS, NY"	1.164																																																					
13282	99	REST OF NEW YORK	0.960																																																					
11502	00	NORTH CAROLINA	0.956																																																					
03302	01	NORTH DAKOTA***	0.980																																																					
15202	00	OHIO	0.963																																																					
04312	00	OKLAHOMA	0.949																																																					
02302	01	"PORTLAND, OR"	1.020																																																					
02302	99	REST OF OREGON	0.976																																																					
12502	01	"METROPOLITAN PHILADELPHIA, PA"	1.061																																																					
12502	99	REST OF PENNSYLVANIA	0.973																																																					
09202	20	PUERTO RICO	1.003																																																					
14412	01	RHODE ISLAND	1.036																																																					
11202	01	SOUTH CAROLINA	0.941																																																					
03402	02	SOUTH DAKOTA***	0.974																																																					
10312	35	TENNESSEE	0.935																																																					
04412	31	"AUSTIN, TX"	0.999																																																					
04412	20	"BEAUMONT, TX"	0.959																																																					
04412	09	"BRAZORIA, TX"	1.002																																																					
04412	11	"DALLAS, TX"	1.002																																																					
04412	28	"FORT WORTH, TX"	0.986																																																					
04412	15	"GALVESTON, TX"	1.008																																																					
04412	18	"HOUSTON, TX"	1.013																																																					
04412	99	REST OF TEXAS	0.963																																																					
03502	09	UTAH	0.974																																																					
14512	50	VERMONT	0.989																																																					
11302	00	VIRGINIA	0.990																																																					
09202	50	VIRGIN ISLANDS	1.003																																																					
02402	02	"SEATTLE (KING CNTY), WA"	1.076																																																					
02402	99	REST OF WASHINGTON	1.001																																																					
11402	16	WEST VIRGINIA	0.949																																																					
06302	00	WISCONSIN	0.953																																																					
03602	21	WYOMING***	0.995																																																					
"MAC assignments as of October 17, 2018"																																																								
																																																								
" * January 1, 2019 through December 31, 2019, the GAF reflects a 1.0 Work GPCI floor as required by the Bipartisan Budget Act of 2018 (February 9, 2018)."																																																								
																																																								
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.																																																								
