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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
MD
MDDOI-MRF-CPT-93458-349
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Maryland Insurance Administration (MIA) & CMS TiC Payer MRF Index
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Baltimore County, MD
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Filing / IDR Window: 2026-11-27
[MDDOI-MRF-CPT-93458-349] CareFirst BlueCross BlueShield Maryland TiC MRF Rate Disparity: Ophthalmology & Anterior Segment Cataract/MIGS ASC (CPT 66984)
Commercial payer TiC MRF negotiated rate benchmark and bilateral/MIGS multiple-procedure reduction (50% MPPR) audit for Md Ophthalmic Ambulatory Surgery Centers (CPT 66984 Extracapsular Cataract Extraction with IOL, CPT 66991 Cataract with Anterior Segment Aqueous Drainage Device, CPT 66821 YAG Laser Capsulotomy, and CPT 65855 Trabeculoplasty) across CareFirst BlueCross BlueShield Maryland & UnitedHealthcare.
Cohort MRF 75th-Pct Value
$1,680,000
Target % of Medicare
211.0% MPFS
Statutory Authority
MD-GPCI-2026 (Md. Code Ins. § 15-1005 (18%–30% 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-93458 | Left Heart Catheterization with Coronary Angiography | CLAIM | 500 | $1,215.40 | $2,822.20 | $3,522.60 |
| CPT-93306 | Transthoracic Echocardiography Complete with Doppler | CLAIM | 240 | $1,762.33 | $4,092.19 | $5,107.77 |
| 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)
The Centers for Advanced Orthopaedics (CAO) BethesdaJohns Hopkins Green Spring Station Surgery CenterOrthoMaryland Quarry Lake Outpatient SurgeryAledade Primary Care NetworkAllied Foot & Ankle, Pc