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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
CO
CODOI-MRF-CPT-45380
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Colorado Division of Insurance (DORA DOI) & CMS TiC Payer MRF Index
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Denver County, CO
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Filing / IDR Window: 2026-11-22
CO Commercial Payer TiC MRF & Modifier-59 Cohort — CPT 45378 / 45380 Gastroenterology
Commercial payer TiC MRF negotiated rate audit, CMS Medicare MPFS RVU/GPCI locality repricing, and ERISA 29 CFR § 2560.503-1 / Federal No Surprises Act (45 CFR § 149.510) IDR arbitration package for Gastroenterology & Endoscopy ASC in CO (CPT 45380 Colonoscopy with Biopsy & ASC Facility Fee).
Cohort MRF 75th-Pct Value
$1,920,000
Target % of Medicare
233.5% MPFS
Statutory Authority
CO-GPCI-2026 (C.R.S. § 10-16-106.5 (20% Prompt-Pay))
ERISA / Timely-Filing Window
180 Days
1. Commercial Payer TiC MRF Allowed-Amount Benchmarks (API #02)
| CPT / DRG Code | Clinical Procedure Description | Unit | Cohort Claims | MRF 25th Pct | MRF Median (QPA) | MRF 75th Pct |
|---|---|---|---|---|---|---|
| CPT 45380 | CPT 45380 Colonoscopy with Biopsy & ASC Facility Fee | CLAIM | 420 | $940.00 | $1,485.00 | $2,140.00 |
| CPT-93458 | Left Heart Catheterization with Coronary Angiography | CLAIM | 540 | $1,215.40 | $2,822.20 | $3,522.60 |
| CPT-93306 | Transthoracic Echocardiography Complete with Doppler | CLAIM | 240 | $1,762.33 | $4,092.19 | $5,107.77 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Rocky Mountain GastroenterologyCO Regional Gastroenterology Associates PACO Ambulatory Gastroenterology Center LLC