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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] Wellmark Blue Cross and Blue Shield of Iowa 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 Ia 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 Wellmark Blue Cross and Blue Shield of Iowa.
Cohort MRF 75th-Pct Value
$1,790,000
Target % of Medicare
238.5% MPFS
Statutory Authority
IA-GPCI-2026 (Iowa Code § 507B.4A (10% 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-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)
Des Moines Orthopaedic Surgeons (DMOS) West ASCSteindler Orthopedic Clinic Iowa City ASCORA Orthopedics Crow Valley Surgery CenterDMOS Orthopaedic Centers IowaORA Orthopedics