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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
AK
AKDOI-MRF-CPT-29881-345
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Alaska Division of Insurance & CMS TiC Payer MRF Index
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Municipality of Anchorage, AK
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Filing / IDR Window: 2026-11-23
[AKDOI-MRF-CPT-29881-345] Ak Premera Blue Cross Blue Shield of Alaska 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 Ak 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 Premera Blue Cross Blue Shield of Alaska & Aetna.
Cohort MRF 75th-Pct Value
$1,720,000
Target % of Medicare
246.5% MPFS
Statutory Authority
AK-GPCI-2026 (AS 21.36.495 (15% 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-29881 | Knee Arthroscopy, Surgical, with Meniscectomy (ASC + Pro) | CLAIM | 580 | $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)
Orthopedic Physicians Anchorage (OPA) Surgery CenterAlaska Spine Institute Outpatient CenterGeneva Woods Surgical Center Anchorage