Medicare payment locality · Q3 2026 release

Metropolitan St. Louis MO Medicare Locality 01

MAC 05302 · Locality 01

This locality's GPCIs are mixed, so the net payment effect varies by code for the Q3 2026 Physician Fee Schedule. For nationally priced services, Medicare adjusts each code's work, practice-expense, and malpractice RVUs using these indexes.

Work GPCI

1.000

Adjusts the physician-work component for professional labor costs

Practice expense GPCI

0.952

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

Malpractice GPCI

1.002

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 Metropolitan St. Louis Copy link

National and Metropolitan St. Louis Office (non-facility) amounts for frequently reviewed codes in the Q3 2026 release (before sequestration). Conversion factor: 2026 standard (non-QP) physician conversion factor · $33.4009.

Code	National	Metropolitan St. Louis	Difference
99214	$135.61	$132.41	-2.4%
99213	$95.19	$92.86	-2.4%
99215	$192.39	$187.99	-2.3%
66984	$462.60	$452.79	-2.1%
99204	$177.36	$173.41	-2.2%
92014	$127.26	$123.49	-3.0%
97110	$29.06	$28.40	-2.3%
88305	$70.14	$67.98	-3.1%
97530	$35.07	$34.11	-2.7%
99203	$117.57	$114.76	-2.4%

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

Metropolitan St. Louis covers 131 ZIP codes across EM, per the CMS ZIP-to-locality crosswalk (Q3 2026). 7 of them span more than one locality and need ZIP+4 for an exact match.

63001 63005 63006 63010 63011 63012 63016 63017 63019 63020 63021 63022 63023 63024 63025 63026 63028 63030 63031 63032 63033 63034 63038 63040 63042 63043 63044 63045 63047 63048 63049 63050 63051 63052 63053 63057 63065 63066 63070 63074 63088 63099 63101 63102 63103 63104 63105 63106 63107 63108 63109 63110 63111 63112 63113 63114 63115 63116 63117 63118 63119 63120 63121 63122 63123 63124 63125 63126 63127 63128 63129 63130 63131 63132 63133 63134 63135 63136 63137 63138 63139 63140 63141 63143 63144 63145 63146 63147 63150 63151 63153 63155 63156 63157 63158 63160 63163 63164 63166 63167 63169 63171 63177 63178 63179 63180 63182 63188 63190 63195 63196 63197 63198 63199 63301 63302 63303 63304 63332 63338 63341 63346 63348 63365 63366 63367 63368 63373 63376 63385 63386

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

Common questions Copy link

Why do Medicare rates in Metropolitan 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. Metropolitan St. Louis currently has mixed GPCI components, so the net payment effect varies by code for the Q3 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 7 ZIP codes in Metropolitan 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 Q3 2026 release (effective July 2026). ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 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 (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 69)

ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

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