Medicare payment locality · Q2 2020 release

Chicago, Il IL Medicare Locality 16

MAC 06102 · Locality 16

This locality's GPCIs are all at or above the national baseline, so normally RVU-priced services tend to price above the national amount for the Q2 2020 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.009

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.039

Adjusts practice-expense inputs such as staff, rent, and services

Malpractice GPCI

1.898

Adjusts the malpractice component using liability-cost data

1.000 is the national baseline. Above raises that component; below lowers it. GPCIs are Medicare payment factors, not general cost-of-living or physician-compensation indexes.

Example rates in Chicago, Il Copy link

National vs. Chicago, Il office (non-facility) amounts for frequently reviewed codes, Q2 2020 (before sequestration). Conversion factor: 2020 standard (non-QP) physician conversion factor · $36.0896.

Code	National	Chicago, Il	Difference
99214	$110.43	$116.53	+5.5%
99213	$76.15	$80.55	+5.8%
99215	$148.33	$156.48	+5.5%
66984	$557.58	$587.80	+5.4%
99204	$167.09	$177.80	+6.4%
92014	$128.12	$133.13	+3.9%
97110	$31.40	$32.76	+4.3%
88305	$71.46	$74.05	+3.6%
97530	$40.42	$42.14	+4.3%
99203	$109.35	$116.11	+6.2%

Need a specific code or a facility rate? Use the rate calculator with this locality selected. Or start from your field's usual procedure mix on the specialty fee schedules.

ZIP codes in this locality Copy link

Chicago, Il covers 228 ZIP codes across IL, per the CMS ZIP-to-locality crosswalk (Q2 2020). 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 60459 60461 60462 60463 60464 60465 60466 60467 60469 60471 60472 60473 60475 60476 60477 60478 60480 60482 60483 60487 60499 60501 60513 60525 60526 60534 60546 60558 60601 60602 60603 60604 60605 60606 60607 60608 60609 60610 60611 60612 60613 60614 60615 60616 60617 60618 60619 60620 60621 60622 60623 60624 60625 60626 60628 60629 60630 60631 60632 60633 60634 60636 60637 60638 60639 60640 60641 60642 60643 60644 60645 60646 60647 60649 60651 60652 60653 60654 60655 60656 60657 60659 60660 60661 60663 60664 60665 60666 60667 60668 60669 60670 60671 60672 60673 60674 60675 60676 60677 60678 60679 60680 60681 60682 60683 60684 60685 60686 60687 60688 60689 60690 60691 60693 60694 60695 60696 60697 60699 60701 60706 60707 60712 60714 60803 60804 60805 60827

Not sure which locality your ZIP is in? Look it up by ZIP code.

Common questions Copy link

Why do Medicare rates in Chicago, Il differ from the national amount?

For nationally priced Physician Fee Schedule services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs by this locality's three GPCIs before applying the conversion factor. Local professional labor, office-input, and liability costs therefore move the final amount up or down. Chicago, Il currently has all three GPCI components at or above the national baseline, so normally RVU-priced services tend to price above the national amount for the Q2 2020 release.

How do I know if my address is in this locality?

Medicare payment localities are geographic fee-schedule areas, commonly defined with county boundaries. CMS uses the service-location ZIP code to map a claim to the applicable carrier and locality. Look up your ZIP to find your locality. About 12 ZIP codes in Chicago, Il span more than one locality and need the ZIP+4 to resolve exactly.

Do commercial insurers or Medicare Advantage plans use this locality?

Original Medicare uses these PFS localities directly. Commercial and Medicare Advantage plans are not required to use the same locality structure. A contract may benchmark payment to Medicare, but its language controls the Medicare release, percentage, geographic basis, and other adjustments.

Does my locality affect what I owe as a patient?

For a particular covered service, a higher locality-adjusted allowed amount generally produces a higher percentage-based coinsurance amount. The effect depends on the code, the beneficiary's deductible, supplemental coverage, and other claim circumstances.

Why did my Medicare payment change even though I didn't change what I billed?

CMS publishes updated PFS files during the year. A code's amount can change because of conversion-factor, RVU, policy, or correction updates. GPCI policy values are generally established through annual rulemaking, although later files can contain corrections. See what changed each release.

Source & method Copy link

GPCIs and rates computed from the CMS Medicare Physician Fee Schedule Q2 2020 release (effective April 2020). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q2 2020 release . Example amounts use the standard (non-QP) physician conversion factor ($36.0896) and apply this locality's GPCIs to nationally priced non-facility RVUs, before the ~2% sequestration cut. Releases are immutable: a rate retrieved for a past quarter always reflects that PFS release.

Geographic practice cost indices (Q2 2020) · rvu20b-updated-05012020.zip (GPCI2020.csv row 50)

ZIP code to carrier locality crosswalk (Q2 2020) · Zip-Code-to-Carrier-Locality.zip (ZIP5_APR2020.txt)

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