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Medicare Physician Fee Schedule · Q3 2026 release

CPT 58100 in Chicago, IL 06102-16

58100 2026 C · Chicago, IL flag06102-16 A Active
Allowed amount
$107.82
in a doctor’s own office or clinic

109.8% of the $98.20 national baseline

Medicare payment
$86.26
Patient / secondary
$21.56
Expected total to provider
$107.82

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

How much does Medicare allow for CPT 58100 in Chicago, IL? Copy link

The Medicare allowed amount is $107.82 in the office (non-facility) setting and $64.51 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 9.8% above the national baseline, and the facility amount is 17.1% above the national baseline. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied — not necessarily what a specific claim pays.

What Medicare locality is Chicago, IL in? Copy link

CMS payment locality Chicago (06102-16). Every location in it is priced identically.

Why Chicago, IL differs from the national amount Copy link

Chicago, IL (this locality)
$107.82
National PFS baseline (GPCI 1.000)
$98.20

The national figure is a baseline, not an amount any provider is paid. This locality's geographic practice cost indices scale each RVU component before the conversion factor is applied, which puts Chicago, IL at 9.8% above the national baseline.

Work GPCI
1.007
Practice expense GPCI
1.005
Malpractice GPCI
2.295
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 58100 in Chicago, IL: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Chicago, IL allowed amount for 58100
Component RVU × GPCI = Adjusted RVU
Work 1.18 1.007 1.1883
Practice expense 1.55 1.005 1.5578
Malpractice 0.21 2.295 0.4820
Sum of adjusted RVUs 3.2280
× $33.4009 2026 conversion factor $107.82

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Chicago, IL allows $64.51 for 58100, versus $107.82 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Chicago, IL. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 58100 in Chicago, IL
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $107.82
Non-participating allowed amount 95% of the participating amount. $102.43
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $117.79
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $86.26
Beneficiary coinsurance The remaining 20%. $21.56
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $1.73
Medicare pays after sequestration Program payment net of the sequestration reduction. $84.53

Contracted rate: % of Medicare in Chicago, IL Copy link

Commercial contracts are usually written as a percentage of the Medicare fee schedule. Which Medicare amount they mean is the part that gets misread: a contract benchmarked to the fee schedule prices off this locality's allowed amount — $107.82 in the office (non-facility) setting — not the $98.20 national baseline.

Opens the calculator already set to Chicago, IL and the office (non-facility) setting. It also compares what a payer actually paid against the expected amount. See how to find your contract's actual percentage.

ZIP codes this Chicago, IL rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 228 ZIP codes to this payment locality. 58100 prices identically in every one of them. 12 of them span more than one locality and need ZIP+4 for an exact match.

60004 60005 60006 60007 60008 60009 60016 60017 60018 60019 60022 60025 60026 60029 60038 60043 60053 60055 60056 60062 60065 60067 60068 60070 60074 60076 60077 60078 60082 60090 60091 60093 60094 60095 60104 60107 60130 60131 60133 60141 60153 60154 60155 60159 60160 60161 60162 60163 60164 60165 60168 60169 60171 60173 60176 60179 60192 60193 60194 60195 60196 60201 60202 60203 60204 60208 60209 60290 60296 60297 60301 60302 60303 60304 60305 60402 60406 60409 60411 60412 60415 60418 60419 60422 60425 60426 60428 60429 60430 60438 60439 60443 60445 60452 60453 60454 60455 60456 60457 60458

128 more ZIP codes map to this locality. The Chicago, IL locality page lists the full set.

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

58100 in nearby payment localities Copy link

Payment localities in the same region as Chicago, IL, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 58100. Proximity doesn't imply similar pricing — neighbouring localities often differ.

58100 allowed amount in payment localities near Chicago, IL
Metro Allowed amount vs. Chicago, IL
Suburban Chicago, IL $105.29 -2.3%
Milwaukee, WI $91.17 -15.4%
Indianapolis, IN $90.81 -15.8%
Detroit, MI $101.20 -6.1%
St. Louis, MO $95.73 -11.2%
Metro East, IL $101.17 -6.2%

Every payment locality nationwide is on the CPT 58100 rate map.

Other codes priced in Chicago, IL Copy link

Office (non-facility) allowed amounts in this same payment locality, Q3 2026.

Other curated codes and their allowed amounts in Chicago, IL
Code Service Chicago, IL vs. national
58558 Women's health $1,307.55 +3.0%
57455 Women's health $177.44 +10.2%
99213 Routine Follow-Up Office Visit $99.63 +4.7%
99214 Long Follow-Up Office Visit $142.45 +5.0%
66984 Cataract Surgery $488.66 +5.6%
92014 Full Eye Exam, Returning Patient $129.71 +1.9%
99204 Long New Patient Office Visit $188.76 +6.4%
99212 Brief Follow-Up Office Visit $62.38 +4.9%
99215 Longest Follow-Up Office Visit $202.59 +5.3%
97110 Physical Therapy Exercises $29.67 +2.1%
99203 New Patient Office Visit $125.16 +6.5%
93010 Heart Tracing Reading $8.83 +5.7%

Common questions Copy link

Which ZIP codes does the Chicago, IL rate for 58100 cover?
The CMS ZIP-to-locality crosswalk maps 228 ZIP codes to this payment locality, and every one of them prices 58100 identically. Examples include 60004, 60005, 60006, 60007, 60008, 60009. 12 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 58100 rate in Chicago, IL different from the national amount?
The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices — work 1.007, practice expense 1.005, malpractice 2.295 — scale each RVU component before the conversion factor is applied, which is why Chicago, IL allows more than the $98.20 baseline.
What is the facility rate for 58100 in Chicago, IL?
$64.51 in a facility, versus $107.82 in the office (non-facility) setting — a $43.31 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 58100 in Chicago, IL?
A non-participating provider is paid $102.43 — 95% of the $107.82 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $117.79, which is 115% of the non-participating amount.
How much of the Chicago, IL 58100 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($86.26) once the annual Part B deductible is met, and the beneficiary owes 20% ($21.56). Sequestration reduces Medicare's share by about 2% ($1.73), leaving $84.53. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q3 2026 release : this code's RVUs from the relative value file, multiplied by payment locality 06102-16's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release . Releases are immutable: an amount retrieved for a past quarter always reflects that PFS release. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 6,456)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 48)
ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Working a claim with an earlier date of service? The calculator prices 58100 in Chicago, IL against the release that governed that date. Past releases need a free account; today's rate does not.

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