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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
WA
WADOI-MRF-CPT-29881-310
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Washington Office of the Insurance Commissioner (WA OIC) & CMS TiC Payer MRF Index
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King County, WA
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Filing / IDR Window: 2026-11-18
[WADOI-MRF-CPT-29881-310] Wa Premera Blue Cross MRF Rate Disparity: Interventional Cardiology & Outpatient Cath/EP Lab (CPT 93458)
Commercial payer TiC MRF negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for Wa Interventional Cardiology & Outpatient Cath Lab procedures (CPT 93458 Left Heart Catheterization with Coronary Angiography, CPT 92928 Percutaneous Transcatheter Coronary Stent Placement, CPT 33249 ICD Pulse Generator & Lead Insertion, and CPT 93306 Complete Transthoracic Echocardiography) across Premera Blue Cross & Regence BlueShield WA.
Cohort MRF 75th-Pct Value
$2,335,000
Target % of Medicare
264.5% MPFS
Statutory Authority
WA-GPCI-2026 (RCW 48.49 & WAC 284-170-431)
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-29881 | Knee Arthroscopy, Surgical, with Meniscectomy (ASC + Pro) | CLAIM | 380 | $582.40 | $1,355.90 | $1,710.80 |
| CPT-27447 | Total Knee Arthroplasty (Condyle and Plateau) | CLAIM | 140 | $844.48 | $1,966.06 | $2,480.66 |
| 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)
Proliance Surgeons Seattle Orthopedic CenterOverlake Medical Pavilion Surgery CenterSwedish First Hill Ambulatory SurgeryAlpine Orthopaedic And Spine A ProfessionalCellNetix