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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
MA
MADOI-MRF-CPT-99285-313
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Massachusetts Division of Insurance (MA DOI) & CMS TiC Payer MRF Index
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Middlesex County, MA
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Filing / IDR Window: 2026-11-21
[MADOI-MRF-CPT-99285-313] Massachusetts UHC, Anthem & BCBS-MA 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 Massachusetts (M.G.L. c. 176G § 6 & c. 175 § 110).
Cohort MRF 75th-Pct Value
$1,975,000
Target % of Medicare
220.5% MPFS
Statutory Authority
MA-GPCI-2026 (M.G.L. c. 176G § 6 & c. 175 § 110)
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 | 500 | $345.00 | $845.00 | $1,090.00 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $500.25 | $1,225.25 | $1,580.50 |
| 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)
Massachusetts Specialty Surgical AssociatesMassachusetts Ambulatory Surgery Center LLCRegional Medical Group of MassachusettsMassachusetts Physician Billing & RCM Partners