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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
GA
GAOCI-MRF-CPT-47562-ATL
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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
[GAOCI-MRF-CPT-47562-ATL] Georgia Blue Cross Blue Shield of Georgia 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 Georgia 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 Blue Cross Blue Shield of Georgia & UnitedHealthcare.
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-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 |
| CPT-64493 | Injection(s), Diagnostic or Therapeutic Agent, Paravertebral Facet (Zygapophyseal) Joint; Lumbar or Sacral, 1st Level | CLAIM | 620 | $287.38 | $621.77 | $794.20 |
| CPT-62323 | Injection(s), of Diagnostic or Therapeutic Substance(s), Interlaminar Epidural or Subarachnoid, Lumbar or Sacral | CLAIM | 670 | $250.80 | $548.62 | $700.15 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Resurgens Orthopaedics St. Joseph's Surgery CenterPeachtree Orthopedics Piedmont Outpatient CenterAtlanta Gastroenterology Associates Endoscopy ASCEmory Orthopaedics & Spine CenterNorthside Hospital Cherokee Surgical Center