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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
OK
OKDOI-MRF-CPT-93458-329
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Oklahoma Insurance Department (OID) & CMS TiC Payer MRF Index
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Oklahoma County, OK
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Filing / IDR Window: 2026-11-27
[OKDOI-MRF-CPT-93458-329] Ok Blue Cross and Blue Shield of Oklahoma MRF Rate Disparity: Interventional Pain Management & Neuromodulation ASC (CPT 63650)
Commercial payer TiC MRF implant device pass-through audit and ERISA 29 CFR 2560.503-1 prior-authorization denial appeal cohort for Ok Interventional Pain Management & Neuromodulation centers (CPT 63650 Percutaneous Spinal Cord Stimulator Lead Implantation, CPT 64635 Lumbar Medial Branch Radiofrequency Ablation, CPT 64493 Lumbar Facet Joint Injection, and CPT 62323 Lumbar Interlaminar Epidural) across Blue Cross and Blue Shield of Oklahoma & HealthChoice.
Cohort MRF 75th-Pct Value
$1,850,000
Target % of Medicare
241.5% MPFS
Statutory Authority
OK-GPCI-2026 (36 O.S. § 1219 (10% Prompt-Pay))
ERISA / Timely-Filing Window
90 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-93458 | Left Heart Catheterization with Coronary Angiography | CLAIM | 420 | $1,250.80 | $2,904.40 | $3,625.20 |
| CPT-93306 | Transthoracic Echocardiography Complete with Doppler | CLAIM | 240 | $1,813.66 | $4,211.38 | $5,256.54 |
| 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)
McBride Orthopedic Hospital Outpatient Center OKCTulsa Bone & Joint Associates Surgery CenterOklahoma Surgical Hospital Outpatient PavilionOutsource Strategies International