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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
GA
GADOI-MRF-CPT-29881
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Georgia Office of Commissioner of Insurance (OCI) & Palmetto GBA JJ MRF Index — Atlanta MSA
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Fulton County, GA
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Filing / IDR Window: 2026-11-30
GA 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 GA (CPT 29881 Arthroscopy, CPT 45380 Endoscopy & CPT 99285 High-Severity E/M).
Cohort MRF 75th-Pct Value
$2,045,000
Target % of Medicare
234.0% MPFS
Statutory Authority
GA-GPCI-2026-ATL (Medicare Locality 10212-01 & O.C.G.A. § 33-24-59.14 12% Prompt-Pay)
ERISA / Timely-Filing Window
90 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-63650 | Percutaneous Implantation of Neurostimulator Electrode Array, Epidural (Spinal Cord Stimulator Trial/Perm) | CLAIM | 165 | $2,591.60 | $5,737.05 | $7,200.05 |
| CPT-64635 | Destruction by Neurolytic Agent, Paravertebral Facet Joint Nerve(s), with Fluoroscopy; Lumbar or Sacral, Single | CLAIM | 415 | $543.40 | $1,191.30 | $1,510.02 |
| CPT-64493 | Injection(s), Diagnostic or Therapeutic Agent, Paravertebral Facet (Zygapophyseal) Joint; Lumbar or Sacral, 1st Level | CLAIM | 620 | $287.38 | $621.77 | $794.20 |
| CPT-62323 | Injection(s), of Diagnostic or Therapeutic Substance(s), Interlaminar Epidural or Subarachnoid, Lumbar or Sacral | CLAIM | 670 | $250.80 | $548.62 | $700.15 |
| 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-45380 | Gastroenterology & Endoscopy ASC: Flexible Colonoscopy with Biopsy & CPT 43239 Upper GI EGD | CLAIM | 610 | $520.00 | $795.00 | $1,140.00 |
| 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)
AMPS Healthcare ClaimsAcademy OrthopedicsAica Orthopedics P.CApex Osn Sc