← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
LA
LADOI-MRF-CPT-45378-327
•
Louisiana Department of Insurance (LDI) & CMS TiC Payer MRF Index
•
East Baton Rouge Parish, LA
•
Filing / IDR Window: 2026-11-25
[LADOI-MRF-CPT-45378-327] Blue Cross and Blue Shield of Louisiana TiC MRF Rate Disparity: Urology & Lithotripsy / Endourology Surgery Center (CPT 52356)
Commercial payer TiC MRF rate disparity audit and ERISA clinical appeal package for La Urology & Lithotripsy Ambulatory Surgery Centers (CPT 52356 Cystourethroscopy with Ureteroscopy, Laser Lithotripsy & Indwelling Stent, CPT 50590 Extracorporeal Shock Wave Lithotripsy ESWL, CPT 52000 Diagnostic Cystourethroscopy, and CPT 52601 Transurethral Electrosurgical Resection of Prostate TURP) across Blue Cross and Blue Shield of Louisiana & Vantage Health.
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)
Ochsner Baptist McFarland Surgery CenterSouthern Orthopaedic Specialists New Orleans ASCBone and Joint Clinic of Baton Rouge Surgery CenterCapitol Imaging ServicesSCP Health