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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NM
NMDOI-MRF-CPT-93458-334
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New Mexico Office of Superintendent of Insurance (OSI) & CMS TiC Payer MRF Index
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Bernalillo County, NM
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Filing / IDR Window: 2026-11-22
[NMDOI-MRF-CPT-93458-334] Blue Cross and Blue Shield of New Mexico TiC MRF Rate Disparity: Interventional Cardiology & Outpatient Cath/EP Lab (CPT 93458 / 92928)
Commercial payer TiC MRF negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for Nm Interventional Cardiology & Outpatient Cath Lab procedures (CPT 93458 Left Heart Catheterization with Coronary Angiography, CPT 92928 Percutaneous Transcatheter Coronary Stent Placement, CPT 33249 ICD Pulse Generator & Lead Insertion, and CPT 93306 Complete Transthoracic Echocardiography) across Blue Cross and Blue Shield of New Mexico & Presbyterian.
Cohort MRF 75th-Pct Value
$2,140,000
Target % of Medicare
254.5% MPFS
Statutory Authority
NM-GPCI-2026 (NMSA 1978 § 59A-16-21.1)
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-93458 | Left Heart Catheterization with Coronary Angiography | CLAIM | 380 | $1,180.00 | $2,740.00 | $3,420.00 |
| CPT-93306 | Transthoracic Echocardiography Complete with Doppler | CLAIM | 240 | $1,711.00 | $3,973.00 | $4,959.00 |
| CPT-99214-25 | Level 4 Established Patient Outpatient E/M with Separately Identifiable Modifier 25 | CLAIM | 1,200 | $115.00 | $172.00 | $204.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
New Mexico Orthopaedics Winrock Surgery CenterPresbyterian Kaseman Ambulatory Surgery CenterLovelace UNM Rehabilitation & Surgical Pavilion