← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
IA
IADOI-MRF-CPT-52356
•
Iowa Insurance Division (IID) & CMS TiC Payer MRF Index
•
Polk County, IA
•
Filing / IDR Window: 2026-11-18
IA Commercial Payer TiC MRF & NSA IDR Cohort — CPT 52000 / 52356 Urology
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 Urology & Lithotripsy in IA (CPT 52356 Cystourethroscopy with Lithotripsy & Stent Insertion).
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)
The Iowa Clinic Urology & SurgeryIA Regional Urology Associates PAIA Ambulatory Urology Center LLC