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Medicare Physician Fee Schedule · Q4 2026 release

CPT 76641 in Chicago, IL

76641 Q4 2026 · Chicago, IL flag06102-16
Office (non-facility) Facility
Locality-adjusted allowed amount
$102.91
in a doctor’s own office or clinic

2.7% above the national baseline ($100.20)

( Work0.71 × 1.007 + Practice exp.2.24 × 1.005 + Malpractice0.05 × 2.295 ) × Conv. factor$33.4009 = $102.91

row 8,736

F Work RVU

0.71

G Non‑facility PE RVU

2.24

K MP RVU

0.05

Z Conversion factor

33.4009

row 48

E Work GPCI

1.007

F PE GPCI

1.005

G MP GPCI

2.295

CMS RVU26DOctober 1 – December 31, 2026revision 2

The Medicare allowed amount is $102.91 in the Office (non-facility) and Facility settings, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.

Q4 2026 · Locality 06102-16 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Chicago, IL in? Copy link

Chicago, IL is in CMS payment locality Chicago (06102-16). The same amount applies everywhere in it.

Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.

ZIP codes in this payment locality (228)

The CMS ZIP-to-locality crosswalk maps 228 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 12 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.

Which ZIP codes does the Chicago, IL rate for 76641 cover?

The CMS ZIP-to-locality crosswalk maps 228 ZIP codes to this payment locality, and 76641 has the same amount in every one of them. Examples include 60004, 60005, 60006, 60007, 60008, 60009. Of these, 12 span more than one payment locality and need ZIP+4 for an exact match.

How locality affects the amount Copy link

Office (non-facility) · Q4 2026 · Participating · Whole service

Chicago, IL (this locality)
$102.91
National PFS baseline (GPCI 1.000)
$100.20

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Chicago, IL 2.7% above the national baseline.

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

CMS RVU26DOctober 1 – December 31, 2026revision 2 See citations

Why is the 76641 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 the Chicago, IL amount is higher than the $100.20 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 76641's RVU components is multiplied by its Chicago, IL GPCI; the products are summed and multiplied by the conversion factor.

Code
76641
DOS
Not selected; uses this release’s rates
Locality
CHICAGO (IL)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q4 2026, revision 2
Sequestration
Shown separately from the allowed amount

Formula

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from.

RVU × GPCI components of Chicago, IL allowed amount for 76641
Component RVU × GPCI = Adjusted
Work 0.71 × 1.007 0.7150
Practice expense · Office (non-facility) 2.24 × 1.005 2.2512
Malpractice 0.05 × 2.295 0.1148
Sum of adjusted RVUs 3.0809
× 33.4009 conversion factor = formula amount $102.91

Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.

  1. Locality-adjusted allowed amount $102.91

    After applicable fee-schedule adjustments; sequestration excluded

Citations

Every input comes from a published CMS file. Open the same file at the row shown and the values match.

  • 76641’s RVUs, PFS status and conversion factor

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

    PPRRVU2026_Oct_nonQPP.csv row 8,736 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    76641
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    0.71
    G Non-facility PE RVU
    2.24
    K MP RVU
    0.05
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 8,734–8,738 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

  • Locality 06102-16’s GPCIs

    Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2

    GPCI2026.csv row 48 in rvu26d-updated-08-26-2026.zip

    A MAC
    06102
    C Locality number
    16
    E Work GPCI
    1.007
    F PE GPCI
    1.005
    G MP GPCI
    2.295
    In the CMS file

    Loading rows 46–50 of GPCI2026.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

CMS RVU26DOctober 1 – December 31, 2026revision 2

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Chicago, IL. Medicare pays part of the allowed amount and the patient pays the rest; the rows below show each figure. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 76641 in Chicago, IL
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $102.91
Non-participating allowed amount 95% of the participating amount. $97.76
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $112.42
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $82.33
Patient coinsurance The remaining 20%. $20.58
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $1.65
Net Medicare payment Medicare's share after the sequestration reduction. $80.68
What is the non-participating amount and limiting charge for 76641 in Chicago, IL?

A non-participating provider is paid $97.76—95% of the $102.91 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $112.42, which is 115% of the non-participating amount.

How much of the Chicago, IL 76641 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($82.33) once the annual Part B deductible is met, and the beneficiary owes 20% ($20.58). Sequestration reduces Medicare's share by about 2% ($1.65), leaving $80.68. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

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

Commercial contracts are often written as a percentage of the Medicare fee schedule. The part that gets misread is which Medicare amount: a contract benchmarked to the fee schedule prices off this locality's allowed amount—$102.91 in the office (non-facility) setting—not the $100.20 national baseline.

Opens the calculator set to Chicago, IL and your selected setting, where you can also compare what a payer paid against the expected amount. See how to find your contract's actual percentage.

Compare 76641 in nearby payment localities

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 76641. Neighboring localities often differ.

76641 allowed amount in payment localities near Chicago, IL
Metro Allowed amount vs. Chicago, IL
Suburban Chicago, IL $103.68 +0.7%
Milwaukee, WI $95.90 -6.8%
Indianapolis, IN $93.88 -8.8%
Detroit, MI $98.73 -4.1%
St. Louis, MO $96.61 -6.1%
Metro East, IL $95.91 -6.8%

Every payment locality nationwide is on the CPT 76641 rate map.

Other codes priced in Chicago, IL Copy link

Office (non-facility) allowed amounts in this same payment locality, Q4 2026.

Other curated codes and their allowed amounts in Chicago, IL
Code and service Allowed vs. national
76700 Complete Abdominal Ultrasound $117.44 +2.8%
76705 Limited Abdominal Ultrasound $88.37 +2.6%
76536 Neck Soft-Tissue Ultrasound $110.86 +2.1%
76856 Ultrasound $107.94 +2.6%
76870 Ultrasound $101.22 +2.7%
76817 Ultrasound $95.52 +2.9%
76815 Ultrasound $84.10 +3.2%
76801 Ultrasound $120.14 +2.8%
76805 Ultrasound $139.70 +2.8%
76816 Ultrasound $113.99 +2.5%
76811 Ultrasound $187.81 +3.2%
99213 Routine Follow-Up Office Visit $99.63 +4.7%

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q4 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, Q4 2026 release. Past releases are never edited, so an amount for an earlier quarter always matches what CMS published for it. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 8,736)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 48)
ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

Working a claim with an earlier date of service? The calculator prices 76641 in Chicago, IL against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.

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