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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
UT
UTDOI-MRF-CPT-66984
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Utah Insurance Department (UID) & CMS TiC Payer MRF Index
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Salt Lake County, UT
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Filing / IDR Window: 2026-11-22
UT Commercial Payer TiC MRF & ASC Facility Cohort — CPT 66984 / 67028 Ophthalmology
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 Ophthalmology & Ophthalmic ASC in UT (CPT 66984 Cataract Extraction with IOL & CPT 67028 Intravitreal Injection).
Cohort MRF 75th-Pct Value
$1,705,000
Target % of Medicare
225.0% MPFS
Statutory Authority
UT-GPCI-2026 (Utah Code § 31A-26-301.6)
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-93458 | Left Heart Catheterization with Coronary Angiography | CLAIM | 460 | $1,073.80 | $2,493.40 | $3,112.20 |
| CPT-93306 | Transthoracic Echocardiography Complete with Doppler | CLAIM | 240 | $1,557.01 | $3,615.43 | $4,512.69 |
| 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)
Hoopes VisionUT Regional Ophthalmology Associates PAUT Ambulatory Ophthalmology Center LLC