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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
CO
CODOI-MRF-CPT-93458-314
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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
[CODOI-MRF-CPT-93458-314] Anthem Blue Cross and Blue Shield of Colorado TiC MRF Rate Disparity: Orthopedic Sports Medicine & Knee/Shoulder ASC (CPT 29881 / 27447)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for Co Orthopedic & ASC surgical claims (CPT 29881 Knee Arthroscopy Meniscectomy, CPT 29827 Arthroscopic Rotator Cuff Repair, CPT 27447 Total Knee Arthroplasty, and CPT 29888 ACL Reconstruction) across Anthem Blue Cross Blue Shield CO & Cigna Mountain.
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-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 |
| CPT-99214-25 | Level 4 Established Patient Outpatient E/M with Separately Identifiable Modifier 25 | CLAIM | 1,200 | $115.00 | $172.00 | $204.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Panorama Orthopedics & Spine Golden ASCSteadman Philippon Surgery Center VailUCHealth Inverness Orthopedics & Spine CenterClinic ServiceColorado Center of Orthopaedic Excellence