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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
IA
IADOI-MRF-CPT-29881-330
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Iowa Insurance Division (IID) & CMS TiC Payer MRF Index
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Polk County, IA
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Filing / IDR Window: 2026-11-18
[IADOI-MRF-CPT-29881-330] Iowa UHC, Anthem & BCBS-IA Commercial MRF Rate Disparity & NSA IDR Benchmark (CPT 29881 / 27447 Orthopedic & ASC Knee Arthroscopy)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for CPT 29881 / 27447 Orthopedic & ASC Knee Arthroscopy in Iowa (Iowa Code § 507B.4A (10% Prompt-Pay)).
Cohort MRF 75th-Pct Value
$2,160,000
Target % of Medicare
212.0% MPFS
Statutory Authority
IA-GPCI-2026 (Iowa Code § 507B.4A (10% Prompt-Pay))
ERISA / Timely-Filing Window
380 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 | Knee Arthroscopy, Surgical, with Meniscectomy (ASC + Pro) | CLAIM | 460 | $697.60 | $1,624.10 | $2,049.20 |
| CPT-27447 | Total Knee Arthroplasty (Condyle and Plateau) | CLAIM | 140 | $1,011.52 | $2,354.94 | $2,971.34 |
| 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)
Iowa Specialty Surgical AssociatesIowa Ambulatory Surgery Center LLCRegional Medical Group of IowaIowa Physician Billing & RCM Partners