East St. Louis (IL) Medicare rates & GPCIs—Q4 2026

Work GPCI

1.000

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

0.920

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

Malpractice GPCI

2.014

Adjusts the malpractice component using liability-cost data

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

Example rates in East St. Louis Copy link

National and East St. Louis Office (non-facility) amounts for frequently reviewed codes in the Q4 2026 release (before sequestration). Conversion factor: 2026 standard (non-QP) physician conversion factor · $33.4009.

Code	National	East St. Louis	Difference
99214	$135.61	$135.01	-0.4%
99213	$95.19	$94.34	-0.9%
99215	$192.39	$192.15	-0.1%
66984	$462.60	$464.48	+0.4%
99204	$177.36	$178.89	+0.9%
92014	$127.26	$122.33	-3.9%
97110	$29.06	$28.30	-2.6%
88305	$70.14	$67.21	-4.2%
97530	$35.07	$33.81	-3.6%
99203	$117.57	$118.29	+0.6%

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

ZIP codes in this locality Copy link

East St. Louis covers 165 ZIP codes across IL, per the CMS ZIP-to-locality crosswalk (Q4 2026). 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 62246 62248 62249 62250 62252 62253 62254 62255 62256 62257 62258 62259 62260 62261 62262 62263 62264 62265 62266 62268 62269 62271 62272 62273 62275 62277 62278 62279 62280 62281 62282 62283 62284 62285 62286 62288 62289 62292 62293 62294 62295 62297 62298 62511 62533 62538 62560 62572 62626 62630 62640 62649 62667 62672 62674 62683 62685 62686 62690 62803 62808 62831 62848 62876 62877

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

Common questions Copy link

Why do Medicare rates in East St. Louis 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 costs for physician work, running an office, and liability insurance therefore move the final amount up or down. East St. Louis currently has mixed GPCI components, so the net payment effect varies by code for the Q4 2026 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 ZIP code where the service was performed to assign a claim to its contractor and locality. Look up your ZIP to find your locality. About 17 ZIP codes in East St. Louis 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 pay a percentage of Medicare, but its own wording decides which Medicare release, percentage, geography, and adjustments apply.

Does my locality affect what I owe as a patient?

For a covered service, a higher allowed amount in your locality usually means a higher 20% coinsurance. 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. GPCIs are usually set once a year in the fee schedule rule, though later files can correct them. See what changed each release.

Source & method Copy link

We compute GPCIs and rates from the CMS Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 2026 release. Example amounts use the standard (non-QP) physician conversion factor ($33.4009) and apply this locality's GPCIs to nationally priced Office (non-facility) RVUs, before the ~2% sequestration cut. Past releases are never edited, so a rate for an earlier quarter always matches what CMS published for it.

Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 49)

ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

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