← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
WY
WYDOI-MRF-CPT-29881
•
Wyoming Department of Insurance (WDOI) & CMS TiC Payer MRF Index
•
Laramie County, WY
•
Filing / IDR Window: 2026-11-26
WY 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 WY (CPT 29881 Knee Arthroscopy & CPT 27447 Total Knee Arthroplasty).
Cohort MRF 75th-Pct Value
$1,510,000
Target % of Medicare
215.0% MPFS
Statutory Authority
WY-GPCI-2026 (Wyo. Stat. § 26-15-124 (10% 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-99285 | Level 5 Emergency Department Visit (High Complexity) | CLAIM | 460 | $345.00 | $845.00 | $1,090.00 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $500.25 | $1,225.25 | $1,580.50 |
| 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)
Premier Bone & Joint CentersTeton Orthopedics JacksonWY Regional Orthopedic Associates PA