← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NC
NCDOI-MRF-CPT-70553-CLT
•
North Carolina Department of Insurance (NCDOI) & Palmetto GBA JM MRF Index — Charlotte / Raleigh MSA
•
Mecklenburg County, NC
•
Filing / IDR Window: 2026-12-01
[NCDOI-MRF-CPT-70553-CLT] Blue Cross and Blue Shield of North Carolina (BCBSNC) TiC MRF Rate Disparity: Orthopedic Sports Medicine & Knee/Shoulder ASC (CPT 29881 / 27447)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for North Carolina Orthopedic & ASC surgical claims (CPT 29881 Knee Arthroscopy Meniscectomy, CPT 29827 Arthroscopic Rotator Cuff Repair, CPT 27447 Total Knee Arthroplasty, and CPT 29888 ACL Reconstruction) across Blue Cross Blue Shield of North Carolina & UnitedHealthcare.
Cohort MRF 75th-Pct Value
$1,985,000
Target % of Medicare
231.0% MPFS
Statutory Authority
NC-GPCI-2026-CLT (Medicare Locality 11502-00 & N.C.G.S. § 58-3-225 18% Prompt-Pay)
ERISA / Timely-Filing Window
180 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-29881 | Knee Arthroscopy, Surgical, with Meniscectomy (Medial OR Lateral, ASC Facility + Pro) | CLAIM | 405 | $662.50 | $1,579.40 | $2,008.70 |
| CPT-29827 | Shoulder Arthroscopy, Surgical, with Rotator Cuff Repair (Modifier 59 / XU Audit) | CLAIM | 240 | $1,208.40 | $2,522.80 | $3,116.40 |
| CPT-27447 | Arthroplasty, Knee, Condyle and Plateau; Medial AND Lateral Compartments (Total Knee) | CLAIM | 140 | $5,035.00 | $9,911.00 | $12,497.40 |
| CPT-29888 | Arthroscopically Aided Anterior Cruciate Ligament (ACL) Repair/Augmentation/Reconstruction | CLAIM | 185 | $1,780.80 | $3,625.20 | $4,441.40 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
OrthoCarolina Mallard Creek Surgery CenterEmergiOrtho Blue Ridge Outpatient SurgeryDuke Ambulatory Surgery Center ArringdonAtrium Health Wake Forest Baptist Outpatient CenterRaleigh Neurosurgical & Spine Clinic ASC