← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
KY
KYDOI-MRF-CPT-99285-328
•
Kentucky Department of Insurance (KDOI) & CMS TiC Payer MRF Index
•
Jefferson County, KY
•
Filing / IDR Window: 2026-11-26
[KYDOI-MRF-CPT-99285-328] Kentucky UHC, Anthem & BCBS-KY Commercial MRF Rate Disparity & NSA IDR Benchmark (CPT 99285 / 00100 Emergency & Anesthesia NSA IDR)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for CPT 99285 / 00100 Emergency & Anesthesia NSA IDR in Kentucky (KRS 304.17A-702 (12%–21% Prompt-Pay)).
Cohort MRF 75th-Pct Value
$1,790,000
Target % of Medicare
195.0% MPFS
Statutory Authority
KY-GPCI-2026 (KRS 304.17A-702 (12%–21% Prompt-Pay))
ERISA / Timely-Filing Window
515 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-99285 | Level 5 Emergency Department Visit (High Complexity) | CLAIM | 380 | $355.35 | $870.35 | $1,122.70 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $515.26 | $1,262.01 | $1,627.91 |
| 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)
Kentucky Specialty Surgical AssociatesKentucky Ambulatory Surgery Center LLCRegional Medical Group of KentuckyKentucky Physician Billing & RCM Partners