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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
GA
GADOI-MRF-CPT-29881
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Georgia Office of Commissioner of Insurance (OCI) & Palmetto GBA JJ MRF Index — Atlanta MSA
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Fulton County, GA
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Filing / IDR Window: 2026-11-30
GA 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 GA (CPT 29881 Knee Arthroscopy & CPT 27447 Total Knee Arthroplasty).
Cohort MRF 75th-Pct Value
$2,045,000
Target % of Medicare
234.0% MPFS
Statutory Authority
GA-GPCI-2026-ATL (Medicare Locality 10212-01 & O.C.G.A. § 33-24-59.14 12% 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 | Orthopedic & ASC: Arthroscopy, Knee, Surgical; with Meniscectomy (Medial/Lateral) & CPT 27447 Total Knee | CLAIM | 420 | $640.00 | $1,185.00 | $1,495.00 |
| CPT-63650 | Percutaneous Implantation of Neurostimulator Electrode Array, Epidural (Spinal Cord Stimulator Trial/Perm) | CLAIM | 165 | $2,591.60 | $5,737.05 | $7,200.05 |
| CPT-64635 | Destruction by Neurolytic Agent, Paravertebral Facet Joint Nerve(s), with Fluoroscopy; Lumbar or Sacral, Single | CLAIM | 415 | $543.40 | $1,191.30 | $1,510.02 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
AMPS Healthcare ClaimsAcademy OrthopedicsAica Orthopedics P.CApex Osn Sc