Medicare payment locality · Q2 2020 release

Suburban Chicago, Il IL Medicare Locality 15

MAC 06102 · Locality 15

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

1.008

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

1.057

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

Malpractice GPCI

1.535

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 Suburban Chicago, Il Copy link

National vs. Suburban 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	Suburban Chicago, Il	Difference
99214	$110.43	$115.97	+5.0%
99213	$76.15	$80.15	+5.3%
99215	$148.33	$155.64	+4.9%
66984	$557.58	$585.51	+5.0%
99204	$167.09	$176.12	+5.4%
92014	$128.12	$133.77	+4.4%
97110	$31.40	$32.74	+4.3%
88305	$71.46	$74.55	+4.3%
97530	$40.42	$42.29	+4.6%
99203	$109.35	$115.32	+5.5%

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

Suburban Chicago, Il covers 155 ZIP codes across IL, per the CMS ZIP-to-locality crosswalk (Q2 2020). 31 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, 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. Suburban 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 31 ZIP codes in Suburban 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 52)

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

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