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Medicare Physician Fee Schedule · Q3 2026 release

CPT 99215 in Metro East, IL 06102-12

Longest follow-up office visit in ZIPs including 62201, 62025, and 62001

99215 2026 C · Metro East, IL flag06102-12 A Active
Allowed amount
$192.15
in a doctor’s own office or clinic

99.9% of the $192.39 national baseline

Medicare payment
$153.72
Patient / secondary
$38.43
Expected total to provider
$192.15

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 99215 in Metro East, IL? Copy link

The Medicare allowed amount is $192.15 in the office (non-facility) setting and $130.70 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 0.1% below the national baseline, and the facility amount is 4.1% 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 Metro East, IL in? Copy link

CMS payment locality East St. Louis (06102-12). Every location in it is priced identically.

Why Metro East, IL differs from the national amount Copy link

Metro East, IL (this locality)
$192.15
National PFS baseline (GPCI 1.000)
$192.39

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 Metro East, IL at 0.1% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.920
Malpractice GPCI
2.014
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 99215 in Metro East, IL: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Metro East, IL allowed amount for 99215
Component RVU × GPCI = Adjusted RVU
Work 2.80 1.000 2.8000
Practice expense 2.75 0.920 2.5300
Malpractice 0.21 2.014 0.4229
Sum of adjusted RVUs 5.7529
× $33.4009 2026 conversion factor $192.15

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Metro East, IL allows $130.70 for 99215, versus $192.15 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 Metro East, 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 99215 in Metro East, IL
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $192.15
Non-participating allowed amount 95% of the participating amount. $182.54
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $209.92
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $153.72
Beneficiary coinsurance The remaining 20%. $38.43
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $3.07
Medicare pays after sequestration Program payment net of the sequestration reduction. $150.65

Contracted rate: % of Medicare in Metro East, 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 — $192.15 in the office (non-facility) setting — not the $192.39 national baseline.

Opens the calculator already set to Metro East, 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 Metro East, IL rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 165 ZIP codes to this payment locality. 99215 prices identically in every one of them. 17 of them span more than one locality and need ZIP+4 for an exact match.

62001 62002 62006 62009 62010 62012 62013 62014 62015 62017 62018 62019 62021 62022 62023 62024 62025 62026 62028 62030 62031 62032 62033 62034 62035 62036 62037 62040 62045 62046 62047 62048 62049 62051 62052 62053 62056 62058 62059 62060 62061 62062 62063 62065 62067 62069 62070 62071 62074 62075 62076 62077 62079 62084 62085 62086 62087 62088 62089 62090 62091 62093 62094 62095 62097 62201 62202 62203 62204 62205 62206 62207 62208 62214 62215 62216 62217 62218 62219 62220 62221 62222 62223 62224 62225 62226 62230 62231 62232 62233 62234 62236 62237 62239 62240 62241 62242 62243 62244 62245

65 more ZIP codes map to this locality. The Metro East, IL locality page lists the full set.

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

99215 in nearby payment localities Copy link

Payment localities in the same region as Metro East, IL, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 99215. Proximity doesn't imply similar pricing — neighbouring localities often differ.

99215 allowed amount in payment localities near Metro East, IL
Metro Allowed amount vs. Metro East, IL
St. Louis, MO $187.99 -2.2%
Chicago, IL $202.59 +5.4%
Suburban Chicago, IL $200.94 +4.6%
Indianapolis, IN $182.08 -5.2%
Louisville, KY $181.60 -5.5%
Kansas City, MO $186.62 -2.9%

Every payment locality nationwide is on the CPT 99215 rate map.

Other codes priced in Metro East, IL Copy link

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

Other curated codes and their allowed amounts in Metro East, IL
Code Service Metro East, IL vs. national
99213 Routine Follow-Up Office Visit $94.34 -0.9%
99214 Long Follow-Up Office Visit $135.01 -0.4%
99204 Long New Patient Office Visit $178.89 +0.9%
99212 Brief Follow-Up Office Visit $58.76 -1.2%
99203 New Patient Office Visit $118.29 +0.6%
99205 Longest New Patient Office Visit $240.37 +1.5%
99202 New Patient Office Visit, Level 2 $74.18 -1.3%
99211 Established Patient Office Visit, Level 1 $23.28 -4.5%
66984 Cataract Surgery $464.48 +0.4%
92014 Full Eye Exam, Returning Patient $122.33 -3.9%
97110 Physical Therapy Exercises $28.30 -2.6%
93010 Heart Tracing Reading $8.50 +1.8%

Common questions Copy link

Which ZIP codes does the Metro East, IL rate for 99215 cover?
The CMS ZIP-to-locality crosswalk maps 165 ZIP codes to this payment locality, and every one of them prices 99215 identically. Examples include 62001, 62002, 62006, 62009, 62010, 62012. 17 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 99215 rate in Metro East, 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 1.000, practice expense 0.920, malpractice 2.014 — scale each RVU component before the conversion factor is applied, which is why Metro East, IL allows less than the $192.39 baseline.
What is the facility rate for 99215 in Metro East, IL?
$130.70 in a facility, versus $192.15 in the office (non-facility) setting — a $61.45 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 99215 in Metro East, IL?
A non-participating provider is paid $182.54 — 95% of the $192.15 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $209.92, which is 115% of the non-participating amount.
How much of the Metro East, IL 99215 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($153.72) once the annual Part B deductible is met, and the beneficiary owes 20% ($38.43). Sequestration reduces Medicare's share by about 2% ($3.07), leaving $150.65. 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 06102-12'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 12,956)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 49)
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 99215 in Metro East, IL against the release that governed that date. The last 12 months price without an account; older dates of service need a free account.

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