← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
FL
FLDOI-MRF-CPT-66984
•
Florida Office of Insurance Regulation (OIR) & First Coast JN MRF Index — Miami-Dade MSA
•
Miami-Dade County, FL
•
Filing / IDR Window: 2026-11-24
FL 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 FL (CPT 66984 Cataract Extraction with IOL & CPT 67028 Intravitreal Injection).
Cohort MRF 75th-Pct Value
$1,560,000
Target % of Medicare
214.5% MPFS
Statutory Authority
FL-GPCI-2026-MIA (Medicare Locality 09102-04 & FL Stat. § 627.6131 12% 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-66984 | Ophthalmology & Ophthalmic ASC: Extracapsular Cataract Removal with IOL Prosthesis & CPT 67028 | CLAIM | 540 | $680.00 | $985.00 | $1,390.00 |
| CPT-45380 | Colonoscopy, Flexible; with Biopsy, Single or Multiple (ASC Facility + Professional) | CLAIM | 920 | $410.00 | $895.00 | $1,140.00 |
| CPT-45385 | Colonoscopy, Flexible; with Removal of Tumor(s), Polyp(s), or Lesion(s) by Snare Technique | CLAIM | 640 | $485.00 | $1,060.00 | $1,345.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
ContinuumCloud HealthcareEye InstituteFL Regional Ophthalmology Associates PA