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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
IL
ILDOI-MRF-CPT-93458-CHI
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Illinois Department of Insurance (IDOI) & NGS J6 MRF Index — Chicago Metro MSA
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Cook County, IL
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Filing / IDR Window: 2026-11-28
[ILDOI-MRF-CPT-93458-CHI] BCBS-IL & UnitedHealthcare Cardiology / Outpatient Cath Lab MRF Rate Benchmark & 215 ILCS 5/368a Prompt-Pay (CPT 93458 / 92928)
Commercial payer MRF negotiated rate benchmark, Prior Authorization (CMS-0057-F) clinical justification packet, and Illinois Insurance Code (215 ILCS 5/368a) statutory 9% interest demand for Outpatient Cardiovascular & Interventional Cath Lab ASCs (CPT 93458 Left Heart Catheterization, CPT 92928 Coronary Stent Placement, and CPT 93306 Complete Transthoracic Echocardiography).
Cohort MRF 75th-Pct Value
$1,940,000
Target % of Medicare
13.0% MPFS
Statutory Authority
IL-GPCI-2026-CHI (Medicare Locality 06102-16 & 215 ILCS 5/368a 9% Prompt-Pay)
ERISA / Timely-Filing Window
480 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-93458 | Catheter Placement in Coronary Artery(s) for Coronary Angiography with Left Heart Cath | CLAIM | 310 | $1,650.00 | $3,890.00 | $4,850.00 |
| CPT-92928 | Percutaneous Transcatheter Placement of Intracoronary Stent(s), Single Major Coronary Artery | CLAIM | 165 | $3,950.00 | $8,450.00 | $10,600.00 |
| CPT-93306 | Echocardiography, Transthoracic, Real-Time with 2D, Spectral & Color Flow Doppler Complete | CLAIM | 1,420 | $185.00 | $420.00 | $535.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Midwest Heart & Vascular InstituteChicagoland Outpatient Cath & Endovascular ASCPrairie State Cardiology Associates SCNorth Shore Interventional Vascular GroupDuPage Cardiovascular & Rhythm Specialists