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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
MN
MNDOI-MRF-CPT-88305
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Minnesota Department of Commerce — Insurance Division & CMS TiC Payer MRF Index
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Hennepin County, MN
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Filing / IDR Window: 2026-11-24
MN Commercial Payer TiC MRF & Lab Reimbursement Cohort — CPT 88305 / 80053
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 Pathology & Clinical Laboratory in MN (CPT 88305 Level IV Surgical Pathology & Out-of-Network Lab Payer MRF Rates).
Cohort MRF 75th-Pct Value
$1,185,000
Target % of Medicare
222.5% MPFS
Statutory Authority
MN-GPCI-2026 (Minn. Stat. § 62Q.75 (18% 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 88305 | CPT 88305 Level IV Surgical Pathology & Out-of-Network Lab Payer MRF Rates | CLAIM | 420 | $940.00 | $1,485.00 | $2,140.00 |
| CPT-63030 | Lumbar Laminotomy (Hemilaminectomy) with Decompression | CLAIM | 380 | $1,983.80 | $4,676.10 | $5,907.80 |
| CPT-22551 | Anterior Cervical Discectomy & Interbody Fusion (ACDF) | CLAIM | 165 | $2,876.51 | $6,780.35 | $8,566.31 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Infinite Health CollaborativeMN Regional Pathology Associates PAMN Ambulatory Pathology Center LLC