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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NC
NCDOI-MRF-CPT-29881
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North Carolina Department of Insurance (NCDOI) & Palmetto GBA JM MRF Index — Charlotte / Raleigh MSA
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Mecklenburg County, NC
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Filing / IDR Window: 2026-12-01
NC 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 NC (CPT 29881 Knee Arthroscopy & CPT 27447 Total Knee Arthroplasty).
Cohort MRF 75th-Pct Value
$1,985,000
Target % of Medicare
231.0% MPFS
Statutory Authority
NC-GPCI-2026-CLT (Medicare Locality 11502-00 & N.C.G.S. § 58-3-225 18% Prompt-Pay)
ERISA / Timely-Filing Window
180 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 | Knee Arthroscopy, Surgical, with Meniscectomy (Medial OR Lateral, ASC Facility + Pro) | CLAIM | 405 | $662.50 | $1,579.40 | $2,008.70 |
| CPT-29827 | Shoulder Arthroscopy, Surgical, with Rotator Cuff Repair (Modifier 59 / XU Audit) | CLAIM | 240 | $1,208.40 | $2,522.80 | $3,116.40 |
| CPT-27447 | Arthroplasty, Knee, Condyle and Plateau; Medial AND Lateral Compartments (Total Knee) | CLAIM | 140 | $5,035.00 | $9,911.00 | $12,497.40 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Bowling OrthopaedicsCape Fear Valley Health Medical GroupPinehurst Surgical ClinicRaleigh Orthopaedic Clinic