← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NV
NVDOI-MRF-CPT-63030
•
Nevada Division of Insurance (NDOI) & CMS TiC Payer MRF Index
•
Clark County, NV
•
Filing / IDR Window: 2026-11-23
NV 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 NV (CPT 63030 Lumbar Discectomy & CPT 22551 Anterior Cervical Fusion (ACDF)).
Cohort MRF 75th-Pct Value
$1,290,000
Target % of Medicare
221.0% MPFS
Statutory Authority
NV-GPCI-2026 (NRS 689A.410 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-29881 | Knee Arthroscopy, Surgical, with Meniscectomy (ASC + Pro) | CLAIM | 500 | $601.60 | $1,400.60 | $1,767.20 |
| CPT-27447 | Total Knee Arthroplasty (Condyle and Plateau) | CLAIM | 140 | $872.32 | $2,030.87 | $2,562.44 |
| 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)
Sierra Neurosurgery Group Reno NVThe Spine & Brain Institute Las VegasNV Regional Neurosurgery Associates PA