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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
FL
FLDOI-MRF-CPT-29881
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Florida Office of Insurance Regulation (OIR) & First Coast JN MRF Index — Miami-Dade MSA
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Miami-Dade County, FL
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Filing / IDR Window: 2026-11-24
FL Commercial Payer TiC MRF & Federal NSA IDR Cohort — Multi-Specialty RCM
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 Multi-Specialty Surgical, ASC & E/M in FL (CPT 29881 Arthroscopy, CPT 45380 Endoscopy & CPT 99285 High-Severity E/M).
Cohort MRF 75th-Pct Value
$1,560,000
Target % of Medicare
214.5% MPFS
Statutory Authority
FL-GPCI-2026-MIA (Medicare Locality 09102-04 & FL Stat. § 627.6131 12% Prompt-Pay)
ERISA / Timely-Filing Window
120 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-29881 | Orthopedic & ASC: Arthroscopy, Knee, Surgical; with Meniscectomy (Medial/Lateral) & CPT 27447 Total Knee | CLAIM | 420 | $640.00 | $1,185.00 | $1,495.00 |
| CPT-45380 | Colonoscopy, Flexible; with Biopsy, Single or Multiple (ASC Facility + Professional) | CLAIM | 920 | $410.00 | $895.00 | $1,140.00 |
| CPT-45385 | Colonoscopy, Flexible; with Removal of Tumor(s), Polyp(s), or Lesion(s) by Snare Technique | CLAIM | 640 | $485.00 | $1,060.00 | $1,345.00 |
| CPT-43239 | Esophagogastroduodenoscopy (EGD), Flexible, Transoral; with Biopsy, Single or Multiple | CLAIM | 580 | $365.00 | $780.00 | $985.00 |
| CPT-63030 | Neurosurgery & Spine: Lumbar Laminotomy/Discectomy (1 Interspace) & CPT 22551 Anterior Cervical ACDF | CLAIM | 185 | $1,480.00 | $2,190.00 | $2,940.00 |
| CPT-66984 | Ophthalmology & Ophthalmic ASC: Extracapsular Cataract Removal with IOL Prosthesis & CPT 67028 | CLAIM | 540 | $680.00 | $985.00 | $1,390.00 |
| CPT-52356 | Urology & Lithotripsy: Cystourethroscopy with Ureteroscopy, Lithotripsy & Indwelling Stent Insertion | CLAIM | 230 | $810.00 | $1,240.00 | $1,745.00 |
| CPT-70553 | Diagnostic Radiology & Cardiology: Brain MRI w/ & w/o Contrast, CPT 74177 CT & CPT 93306 Echo | CLAIM | 480 | $410.00 | $685.00 | $995.00 |
| CPT-99285 | Emergency Medicine, Pathology & Anesthesia: Level-5 E/M, CPT 88305 Surgical Path & CPT 01402 QPA | CLAIM | 890 | $340.00 | $565.00 | $845.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Aspect Billing SolutionsContinuumCloud HealthcareFirst Choice Medical BillingMedbillingExperts