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Illinois Medicare fee schedule 2026: 4 payment localities

Illinois is split into 4 Medicare payment localities, each with its own 2026 geographic practice cost indices. This page compares them, shows what the same codes pay in each, and lists the statewide DMEPOS amounts; every locality has its own page with its counties and full ZIP code list.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: PFS GPCIs, anesthesia conversion factors and localities: CY2026 Addendum E (RVU26D) (effective January 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); ZIP code to carrier locality file: ZIP5 October 2026 (file updated August 13, 2026) (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026). Next CMS release: CY2027 PFS final rule (November 2026), effective January 1, 2027 for the PFS GPCIs, anesthesia conversion factors and localities; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; January 1, 2027 (quarterly update) for the ZIP code to carrier locality file and DMEPOS fee schedule.

TL;DR

Illinois has 4 Medicare payment localities for 2026: Chicago (06102-16), East St. Louis (06102-12), Suburban Chicago (06102-15) and Rest of Illinois (06102-99). The geographic adjustment factor runs from 0.985 in Rest of Illinois to 1.061 in Chicago, so 99213 in an office pays $92.64 in Rest of Illinois and $99.63 in Chicago. The localities cover 1,630 ZIP codes, 703 of them rural or super rural in the CMS ZIP file, and Wellpoint Federal processes the Part B claims.

Illinois localities at a glance

Payment localities
4
Wellpoint Federal
GAF range
0.985 to 1.061
+7.7% from lowest to highest
ZIP codes
1,630
578 rural, 125 super rural
DMEPOS rural ZIP codes
686
on the quarter 4 2026 list

The 4 localities and their 2026 GPCIs

Medicare payment localities in Illinois with 2026 GPCIs, GAF and counties
Locality and countiesWorkPEMPGAF
Chicago 06102-16Cook · 228 ZIP codes1.0071.0052.2951.061
Suburban Chicago 06102-15DuPage, Kane, Lake and Will · 155 ZIP codes1.0071.0271.7721.049
East St. Louis 06102-12Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Randolph, St. Clair and Washington · 165 ZIP codes1.0000.9202.0141.008
Rest of Illinois 06102-99All Other Counties · 1,082 ZIP codes1.0000.9131.5630.985

A service is priced at the locality where it is furnished, which CMS resolves from the ZIP code of the service location, not from where the patient lives or where the practice is headquartered. A group with offices in several Illinois localities is therefore paid different amounts for the same code; each locality page lists its ZIP codes.

The same codes across Illinois

Non-facility amounts at the 2026 non-QP conversion factor for the global service; CPT numbers are shown without descriptors. The spread between the first and last row is the geographic adjustment alone, since the RVUs and the conversion factor are the same statewide.

2026 Medicare office payments for example codes in each Illinois locality
Locality9921399214G2211G0439G040220610
Chicago$99.63$142.45$18.34$144.03$183.06$74.80
Suburban Chicago$99.13$141.47$18.11$143.28$181.90$73.38
East St. Louis$94.34$135.01$17.59$136.48$173.87$70.11
Rest of Illinois$92.64$132.43$17.25$134.04$170.74$67.88

DMEPOS amounts in Illinois

Durable medical equipment, prosthetics, orthotics and supplies are not priced by locality. The October 2026 DMEPOS fee schedule (DME26-D) sets one non-rural and one rural amount per code for the whole state, and the rural amount applies only in the ZIP codes on the quarterly DMEPOS rural list. The table shows the Illinois amounts for common items next to the lowest and highest non-rural amount among the contiguous states; HCPCS Level II descriptors are CMS's.

DMEPOS fee schedule amounts in Illinois, October 2026
CodeItemNon-ruralRuralContiguous states
E0601-RRContinuous positive airway pressure (cpap) devicecapped rental, monthly rental$52.65$97.02$50.04 to $52.65
E0260-RRHospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattresscapped rental, monthly rental$75.89$128.14$72.80 to $78.16
K0001-RRStandard wheelchaircapped rental, monthly rental$29.59$53.64$25.23 to $31.07
E0143-NUWalker, folding, wheeled, adjustable or fixed heightinexpensive or routinely purchased, purchased new$60.25$106.25$55.55 to $60.89
E0114-NUCrutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgripsinexpensive or routinely purchased, purchased new$67.26—$57.17 to $67.26
A4253-NUBlood glucose test or reagent strips for home blood glucose monitor, per 50 stripsinexpensive or routinely purchased, purchased new$8.32—$8.32 in every state
L1833Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelfprosthetics and orthotics$509.63$701.41$455.16 to $556.31
E0784-RRExternal ambulatory infusion pump, insulincapped rental, monthly rental$557.75$576.36$557.75 in every state
Former competitive bidding areas use CMS's separate former CBA fee schedule for the items it lists; see the DMEPOS fee schedule page.

Contractor, coverage and other payment systems

Part B claims in Illinois are processed by Wellpoint Federal, whose local coverage determinations decide which services are covered and with which diagnoses. The locality adjusts only physician fee schedule payments. Clinical laboratory tests are paid at one national amount from the Clinical Laboratory Fee Schedule, hospital outpatient services through APCs adjusted by each hospital's wage index rather than by these indices, and Part B drugs at the national ASP payment limits. QuickIntell's Illinois page covers the state's payers and revenue-cycle requirements.

Where QuickIntell fits for Illinois practices

Contract management in QuickRCM keeps payer contracts and fee schedules with their effective dates and compares expected reimbursement against allowed amounts, so a claim priced at the wrong locality, or with last year's indices, is reviewed before a dispute is opened.

See contract management in QuickRCMSee QuickRCMBook a meeting

Frequently asked questions

How many Medicare localities are in Illinois?

4 for 2026: Chicago (locality 06102-16, GAF 1.061), Suburban Chicago (locality 06102-15, GAF 1.049), East St. Louis (locality 06102-12, GAF 1.008) and Rest of Illinois (locality 06102-99, GAF 0.985). Rest of Illinois covers every county not named for another locality.

Which Illinois locality pays the most?

Chicago, with a geographic adjustment factor of 1.061 (work 1.007, practice expense 1.005, malpractice 2.295). The lowest is Rest of Illinois at 0.985, so the same service pays about 7.7% more in Chicago.

Which counties are in each Illinois locality?

Chicago: Cook. Suburban Chicago: DuPage, Kane, Lake and Will. East St. Louis: Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Randolph, St. Clair and Washington. Rest of Illinois: All Other Counties.

Does the DMEPOS fee schedule use the same Illinois localities?

No. DMEPOS amounts are statewide, with a non-rural and a rural amount for each code; E0601-RR is $52.65 non-rural in Illinois and $97.02 rural in October 2026, whichever physician fee schedule locality the beneficiary lives in.

More on Medicare localities

Every locality and the ZIP code finder are on the Medicare payment localities hub; the national GPCI table with anesthesia conversion factors is on the physician fee schedule page, and the fee schedules hub maps which CMS schedule pays which claim.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Operational reference compiled from CMS physician fee schedule and DMEPOS public use files. Amounts are Medicare fee schedule amounts before the deductible, coinsurance, sequestration and claim-level reductions; Medicare Advantage and commercial contracts set their own rates. CPT codes appear as bare numbers; CPT descriptors are copyright AMA. Not legal, coding or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.