Medicare payment locality · Q4 2026 release

Suburban Chicago IL Medicare Locality 15

MAC 06102 · Locality 15

This locality's GPCIs are all at or above the national baseline, so services priced with the standard RVU formula usually come out above the national amount for the Q4 2026 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.007

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.027

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

Malpractice GPCI

1.772

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 Suburban Chicago Copy link

National and Suburban Chicago 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	Suburban Chicago	Difference
99214	$135.61	$141.47	+4.3%
99213	$95.19	$99.13	+4.1%
99215	$192.39	$200.94	+4.4%
66984	$462.60	$483.74	+4.6%
99204	$177.36	$186.38	+5.1%
92014	$127.26	$130.74	+2.7%
97110	$29.06	$29.79	+2.5%
88305	$70.14	$72.05	+2.7%
97530	$35.07	$35.97	+2.6%
99203	$117.57	$123.66	+5.2%

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

ZIP codes in this locality Copy link

Suburban Chicago covers 155 ZIP codes across IL, per the CMS ZIP-to-locality crosswalk (Q4 2026). 30 of them span more than one locality and need ZIP+4 for an exact match.

60002 60010 60011 60015 60020 60030 60031 60035 60037 60040 60041 60042 60044 60045 60046 60047 60048 60049 60060 60061 60064 60069 60073 60075 60079 60083 60084 60085 60086 60087 60088 60089 60092 60096 60099 60101 60103 60105 60106 60108 60109 60110 60114 60116 60117 60118 60119 60120 60121 60122 60123 60124 60125 60126 60128 60132 60134 60136 60137 60138 60139 60140 60143 60144 60147 60148 60151 60157 60170 60172 60174 60175 60177 60181 60182 60183 60184 60185 60186 60187 60188 60189 60190 60191 60197 60198 60199 60398 60399 60401 60403 60404 60408 60410 60417 60421 60423 60431 60432 60433 60434 60435 60436 60440 60441 60442 60446 60448 60449 60451 60468 60481 60484 60490 60491 60502 60503 60504 60505 60506 60507 60510 60511 60514 60515 60516 60517 60519 60521 60522 60523 60527 60532 60539 60540 60542 60544 60554 60555 60559 60561 60563 60564 60565 60566 60567 60568 60569 60570 60572 60585 60586 60597 60598 60599

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

Common questions Copy link

Why do Medicare rates in Suburban Chicago 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. Suburban Chicago currently has all three GPCIs at or above the national baseline, so services priced with the standard RVU formula usually come out above the national amount 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 30 ZIP codes in Suburban Chicago 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 50)

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

Did this answer your question about Suburban Chicago (IL)?

We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.