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We note that the CY 2026 GPCI update was calculated using current, disaggregated data that reflects regional cost variation within each state, as requested by the commenter, and therefore the published CY 2026 PE GPCI in Addendum E does account for county-level differences weighted by Medicare PFS RVUs and population by country (as described in the “Interim Report for the CY 2026 Update of GPCIs and MP RVUs for the Medicare Physician Fee Schedule,” available on the CMS website under the downloads section of the CY 2026 PFS proposed rule at )