Suburban Chicago, IL (Locality 06102-15)
3.3% above the national baseline ($126.26)
CMS RVU26DOctober 1 – December 31, 2026revision 2
( Work0.74 × 1.007 + Practice exp.2.99 × 1.027 + Malpractice0.05 × 1.772 ) × Conv. factor$33.4009 = $130.41
F Work RVU
0.74
G Non‑facility PE RVU
2.99
K MP RVU
0.05
Z Conversion factor
33.4009
E Work GPCI
1.007
F PE GPCI
1.027
G MP GPCI
1.772
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Physician relative value file (PPRRVU) · PPRRVU2026_Oct_nonQPP.csv row 8,982 in rvu26d-updated-08-26-2026.zip Download from CMS
Loading rows 8,980–8,984 of PPRRVU2026_Oct_nonQPP.csv…
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Geographic practice cost indices (GPCI) · GPCI2026.csv row 50 in rvu26d-updated-08-26-2026.zip Download from CMS
Loading rows 48–52 of GPCI2026.csv…
The Medicare allowed amount is $130.41 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.
Assumes a participating provider, no modifiers, the whole service, before sequestration.
Customize service date, participation, and modifiers Check service-location ZIP CMS sources and method
What Medicare locality is Suburban Chicago, IL in? Copy link
Suburban Chicago, IL is in CMS payment locality Suburban Chicago (06102-15). 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 (155)
The CMS ZIP-to-locality crosswalk maps 155 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 30 span more than one locality and need ZIP+4 for an exact match.
55 more ZIP codes map to this locality. The Suburban Chicago, IL locality page lists the full set.
Which ZIP codes does the Suburban Chicago, IL rate for 77067 cover?
The CMS ZIP-to-locality crosswalk maps 155 ZIP codes to this payment locality, and 77067 has the same amount in every one of them. Examples include 60002, 60010, 60011, 60015, 60020, 60030. Of these, 30 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
Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Suburban Chicago, IL 3.3% above the national baseline.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows
Why is the 77067 rate in Suburban 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 1.027, malpractice 1.772—scale each RVU component before the conversion factor is applied, which is why the Suburban Chicago, IL amount is higher than the $126.26 baseline.
Formula and inputs Copy link
For the office (non-facility) amount, each of 77067's RVU components is multiplied by its Suburban Chicago, IL GPCI; the products are summed and multiplied by the conversion factor.
- Code
- 77067
- DOS
- Not selected; uses this release’s rates
- Locality
- SUBURBAN 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.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 0.74 | × 1.007 | 0.7452 |
| Practice expense · Office (non-facility) | 2.99 | × 1.027 | 3.0707 |
| Malpractice | 0.05 | × 1.772 | 0.0886 |
| Sum of adjusted RVUs | 3.9045 | ||
| × 33.4009 conversion factor = formula amount | $130.41 | ||
Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.
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Locality-adjusted allowed amount $130.41
After applicable fee-schedule adjustments; sequestration excluded
Citations
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77067’s RVUs, PFS status and conversion factor
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
PPRRVU2026_Oct_nonQPP.csv row 8,982 in rvu26d-updated-08-26-2026.zip
- A HCPCS
- 77067
- B Modifier
- blank
- D Status code
- A
- F Work RVU
- 0.74
- G Non-facility PE RVU
- 2.99
- K MP RVU
- 0.05
- Z Conversion factor
- 33.4009
In the CMS file
Loading rows 8,980–8,984 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626 -
Locality 06102-15’s GPCIs
Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2
GPCI2026.csv row 50 in rvu26d-updated-08-26-2026.zip
- A MAC
- 06102
- C Locality number
- 15
- E Work GPCI
- 1.007
- F PE GPCI
- 1.027
- G MP GPCI
- 1.772
In the CMS file
Loading rows 48–52 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 Suburban 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.
| Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. | $130.41 |
|---|---|
| Non-participating allowed amount 95% of the participating amount. | $123.89 |
| Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. | $142.47 |
| Medicare share 80% of the allowed amount, once the annual Part B deductible is met. | $104.33 |
| Patient coinsurance The remaining 20%. | $26.08 |
| Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. | $2.09 |
| Net Medicare payment Medicare's share after the sequestration reduction. | $102.24 |
What is the non-participating amount and limiting charge for 77067 in Suburban Chicago, IL?
A non-participating provider is paid $123.89—95% of the $130.41 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $142.47, which is 115% of the non-participating amount.
How much of the Suburban Chicago, IL 77067 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($104.33) once the annual Part B deductible is met, and the beneficiary owes 20% ($26.08). Sequestration reduces Medicare's share by about 2% ($2.09), leaving $102.24. Sequestration never changes the allowed amount itself, which is why it is shown separately here.
Contracted rate: % of Medicare in Suburban 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—$130.41 in the office (non-facility) setting—not the $126.26 national baseline.
Opens the calculator set to Suburban 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.
77067 in nearby payment localities Copy link
Payment localities in the same region as Suburban Chicago, IL, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 77067. Neighboring localities often differ.
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Suburban Chicago, IL · this page $130.41
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Chicago, IL $129.09 -1.0%
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Milwaukee, WI $120.91 -7.3%
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Indianapolis, IN $118.11 -9.4%
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Detroit, MI $123.91 -5.0%
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St. Louis, MO $121.47 -6.9%
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Metro East, IL $119.96 -8.0%
Percentages are against Suburban Chicago, IL. Every payment locality nationwide is on the CPT 77067 rate map.
Other codes priced in Suburban Chicago, IL Copy link
Office (non-facility) allowed amounts in this same payment locality, Q4 2026.
| Code and service | Allowed | vs. national |
|---|---|---|
| 77080 Central Bone Density Study | $40.84 | +3.6% |
| 77065 Unilateral Diagnostic Mammography | $128.23 | +3.5% |
| 77066 Bilateral Diagnostic Mammography | $162.56 | +3.6% |
| 99213 Routine Follow-Up Office Visit | $99.13 | +4.1% |
| 99214 Long Follow-Up Office Visit | $141.47 | +4.3% |
| 66984 Cataract Surgery | $483.74 | +4.6% |
| 92014 Full Eye Exam, Returning Patient | $130.74 | +2.7% |
| 99204 Long New Patient Office Visit | $186.38 | +5.1% |
| 99212 Brief Follow-Up Office Visit | $62.08 | +4.4% |
| 99215 Longest Follow-Up Office Visit | $200.94 | +4.4% |
| 97110 Physical Therapy Exercises | $29.79 | +2.5% |
| 99203 New Patient Office Visit | $123.66 | +5.2% |
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 06102-15'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.
Working a claim with an earlier date of service? The calculator prices 77067 in Suburban 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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