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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
AL
ALDOI-MRF-CPT-63030-326
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Alabama Department of Insurance (ALDOI) & CMS TiC Payer MRF Index
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Jefferson County, AL
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Filing / IDR Window: 2026-11-24
[ALDOI-MRF-CPT-63030-326] Blue Cross and Blue Shield of Alabama TiC MRF Rate Disparity: Interventional Cardiology & Outpatient Cath/EP Lab (CPT 93458 / 92928)
Commercial payer TiC MRF negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for Al 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 Blue Cross and Blue Shield of Alabama & Viva Health.
Cohort MRF 75th-Pct Value
$2,205,000
Target % of Medicare
252.0% MPFS
Statutory Authority
AL-GPCI-2026 (Ala. Code § 27-1-19 (18% Prompt-Pay))
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-63030 | Lumbar Laminotomy (Hemilaminectomy) with Decompression | CLAIM | 540 | $1,765.40 | $4,161.30 | $5,257.40 |
| CPT-22551 | Anterior Cervical Discectomy & Interbody Fusion (ACDF) | CLAIM | 165 | $2,559.83 | $6,033.89 | $7,623.23 |
| 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)
Andrews Sports Medicine & Orthopaedic Center BirminghamOrthoSports Associates St. Vincent's ASCAlabama Orthopaedic Clinic PC Mobile Surgery CenterAndrews Sports Medicine Birmingham ALEye Center South Dothan AL