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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NH
NHDOI-MRF-CPT-63030
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New Hampshire Insurance Department (NHID) & CMS TiC Payer MRF Index
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Hillsborough County, NH
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Filing / IDR Window: 2026-11-26
NH Commercial Payer TiC MRF & ERISA Appeal Cohort — CPT 63030 / 22551 Spine & Neurosurgery
Commercial payer TiC MRF negotiated rate audit, CMS Medicare MPFS RVU/GPCI locality repricing, and ERISA 29 CFR § 2560.503-1 / Federal No Surprises Act (45 CFR § 149.510) IDR arbitration package for Neurosurgery & Spine in NH (CPT 63030 Lumbar Discectomy & CPT 22551 Anterior Cervical Fusion (ACDF)).
Cohort MRF 75th-Pct Value
$1,725,000
Target % of Medicare
241.0% MPFS
Statutory Authority
NH-GPCI-2026 (RSA 420-J:8-a (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-99285 | Level 5 Emergency Department Visit (High Complexity) | CLAIM | 540 | $313.95 | $768.95 | $991.90 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $455.23 | $1,114.98 | $1,438.25 |
| 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)
New Hampshire NeuroSpine InstituteNH Regional Neurosurgery Associates PANH Ambulatory Neurosurgery Center LLC