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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NY
NYDOI-MRF-CPT-29881
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New York State Department of Financial Services (NYDFS) & NGS JK MRF Index — New York Metro MSA
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Nassau County, NY
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Filing / IDR Window: 2026-11-27
NY Commercial Payer TiC MRF & NSA IDR Cohort — CPT 29881 / 27447 Orthopedic & ASC
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 Orthopedic & ASC Surgery in NY (CPT 29881 Knee Arthroscopy & CPT 27447 Total Knee Arthroplasty).
Cohort MRF 75th-Pct Value
$1,665,000
Target % of Medicare
231.5% MPFS
Statutory Authority
NY-GPCI-2026-NYC (Medicare Locality 13202-01 & NY Ins. Law § 3224-a 12% 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 | Orthopedic & ASC: Arthroscopy, Knee, Surgical; with Meniscectomy (Medial/Lateral) & CPT 27447 Total Knee | CLAIM | 420 | $640.00 | $1,185.00 | $1,495.00 |
| CPT-52356 | Cystourethroscopy, with Ureteroscopy and/or Pyeloscopy; with Lithotripsy Including Insertion of Indwelling Ureteral Stent | CLAIM | 240 | $1,400.70 | $3,024.70 | $3,796.10 |
| CPT-50590 | Lithotripsy, Extracorporeal Shock Wave (ESWL) — Renal/Ureteral Calculus (ASC Facility + Professional) | CLAIM | 195 | $1,309.35 | $2,831.85 | $3,532.20 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Active Sports Medicine & Orthopaedic Surgery PcEckert & ZieglerManhattan Orthopedic CareMedical Billing Star