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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
GA
GAOCI-MRF-CPT-47562-ATL
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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
[GAOCI-MRF-CPT-47562-ATL] Anthem BCBS-GA & Ambetter General Surgery / Bariatric ASC MRF Rate Spread & O.C.G.A. § 33-24-59.14 Prompt-Pay (CPT 47562 / 49650)
Commercial payer MRF negotiated rate audit, Georgia Surprise Billing Consumer Protection Act (O.C.G.A. § 33-20E) arbitration brief, and O.C.G.A. § 33-24-59.14 12% statutory prompt-pay interest demand for General & Minimally Invasive Surgery Centers (CPT 47562 Laparoscopic Cholecystectomy, CPT 49650 Laparoscopic Inguinal Hernia Repair, and CPT 43775 Laparoscopic Sleeve Gastrectomy).
Cohort MRF 75th-Pct Value
$1,680,000
Target % of Medicare
12.5% 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
410 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-47562 | Laparoscopy, Surgical; Cholecystectomy (ASC Facility + Professional Fee Benchmark) | CLAIM | 390 | $1,280.00 | $2,890.00 | $3,650.00 |
| CPT-49650 | Laparoscopy, Surgical; Repair Initial Inguinal Hernia (Mesh Prosthesis Included) | CLAIM | 440 | $1,190.00 | $2,640.00 | $3,340.00 |
| CPT-43775 | Laparoscopy, Surgical, Gastric Restrictive Procedure; Longitudinal Gastrectomy (Sleeve) | CLAIM | 150 | $2,950.00 | $6,420.00 | $8,150.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Peachtree Surgical & Bariatric SpecialistsAtlanta Minimally Invasive Surgery CenterPiedmont Perimeter General Surgery GroupSouthern Regional Endosurgery AssociatesBuckhead Ambulatory Surgical Partners