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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
LA
LADOI-MRF-CPT-29881
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Louisiana Department of Insurance (LDI) & CMS TiC Payer MRF Index
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East Baton Rouge Parish, LA
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Filing / IDR Window: 2026-11-25
LA Commercial Payer TiC MRF & Federal NSA IDR Cohort — Multi-Specialty RCM
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 Multi-Specialty Surgical, ASC & E/M in LA (CPT 29881 Arthroscopy, CPT 45380 Endoscopy & CPT 99285 High-Severity E/M).
Cohort MRF 75th-Pct Value
$1,470,000
Target % of Medicare
221.5% MPFS
Statutory Authority
LA-GPCI-2026 (La. R.S. 22:1832 (12% Prompt-Pay))
ERISA / Timely-Filing Window
120 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-45378 | Diagnostic Colonoscopy with Biopsy (ASC Facility + Pro) | CLAIM | 580 | $410.00 | $965.00 | $1,215.00 |
| CPT-43239 | Upper GI Endoscopy (EGD) with Biopsy | CLAIM | 190 | $594.50 | $1,399.25 | $1,761.75 |
| 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)
SCP HealthLA Regional Multi-Specialty Surgical, ASC Associates PALA Ambulatory Multi-Specialty Surgical, ASC Center LLC