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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NC
NCDOI-MRF-CPT-70553-CLT
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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
[NCDOI-MRF-CPT-70553-CLT] Blue Cross NC & Cigna Diagnostic Imaging / IDTF MRI MRF Rate Benchmark & N.C.G.S. § 58-3-225 Prompt-Pay (CPT 70553 / 72148)
Commercial payer MRF negotiated rate benchmark, Radiology Benefit Manager (EviCore / Carelon) clinical medical necessity appeal, and N.C.G.S. § 58-3-225 18% per annum statutory interest demand for Diagnostic Imaging Centers & IDTFs (CPT 70553 MRI Brain w/ & w/o Contrast, CPT 72148 MRI Lumbar Spine w/o Contrast, and CPT 73721 MRI Lower Extremity Joint).
Cohort MRF 75th-Pct Value
$1,390,000
Target % of Medicare
11.5% 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
360 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-70553 | Magnetic Resonance (e.g., Proton) Imaging, Brain (Including Brain Stem); w/o & w/ Contrast | CLAIM | 820 | $340.00 | $790.00 | $985.00 |
| CPT-72148 | Magnetic Resonance Imaging, Spinal Canal and Contents, Lumbar; without Contrast Material | CLAIM | 1,350 | $245.00 | $565.00 | $715.00 |
| CPT-73721 | Magnetic Resonance Imaging, Any Joint of Lower Extremity; without Contrast Material | CLAIM | 980 | $235.00 | $540.00 | $685.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Carolina Advanced MRI & Diagnostic ImagingPiedmont Triad Radiology Associates PAQueen City Open Upright MRI CenterResearch Triangle Musculoskeletal ImagingBlue Ridge Outpatient Diagnostic Partners