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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
IN
INDOI-MRF-CPT-29881
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Indiana Department of Insurance (IDOI) & CMS TiC Payer MRF Index
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Marion County, IN
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Filing / IDR Window: 2026-11-26
IN Commercial Payer TiC MRF & NSA IDR Cohort — CPT 29881 / 27447 Orthopedic & ASC
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 Orthopedic & ASC Surgery in IN (CPT 29881 Knee Arthroscopy & CPT 27447 Total Knee Arthroplasty).
Cohort MRF 75th-Pct Value
$2,270,000
Target % of Medicare
267.0% MPFS
Statutory Authority
IN-GPCI-2026 (IC 27-8-5.7-6 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 | CPT 29881 Knee Arthroscopy & CPT 27447 Total Knee Arthroplasty | CLAIM | 420 | $940.00 | $1,485.00 | $2,140.00 |
| CPT-99285 | Level 5 Emergency Department Visit (High Complexity) | CLAIM | 460 | $324.30 | $794.30 | $1,024.60 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $470.24 | $1,151.73 | $1,485.67 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Fort Wayne OrthopedicsRevele Healthcare RCM & eClinicalWorksIN Regional Orthopedic Associates PA