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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
MN
MNDOI-MRF-CPT-63030-316
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Minnesota Department of Commerce — Insurance Division & CMS TiC Payer MRF Index
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Hennepin County, MN
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Filing / IDR Window: 2026-11-24
[MNDOI-MRF-CPT-63030-316] Blue Cross and Blue Shield of Minnesota TiC MRF Rate Disparity: Gastroenterology & Ambulatory Endoscopy Center (CPT 45378 / 43239)
Commercial payer TiC MRF facility vs. professional rate spread audit and NCCI PTP Modifier 59/PT unbundling defense for Mn Gastroenterology Endoscopy centers (CPT 45378 Diagnostic Colonoscopy, CPT 45385 Colonoscopy with Snare Polypectomy, CPT 43239 Upper GI Endoscopy EGD with Biopsy, and CPT 00812 Screening Anesthesia) across Blue Cross and Blue Shield of Minnesota & Medica.
Cohort MRF 75th-Pct Value
$1,185,000
Target % of Medicare
222.5% MPFS
Statutory Authority
MN-GPCI-2026 (Minn. Stat. § 62Q.75 (18% 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-63030 | Lumbar Laminotomy (Hemilaminectomy) with Decompression | CLAIM | 380 | $1,983.80 | $4,676.10 | $5,907.80 |
| CPT-22551 | Anterior Cervical Discectomy & Interbody Fusion (ACDF) | CLAIM | 165 | $2,876.51 | $6,780.35 | $8,566.31 |
| 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)
Twin Cities Orthopedics (TCO) Eagan ASCTRIA Orthopedic Center BloomingtonM Health Fairview Clinics & Surgery CenterTwin Cities Orthopedics