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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NV
NVDOI-MRF-CPT-29881-325
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Nevada Division of Insurance (NDOI) & CMS TiC Payer MRF Index
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Clark County, NV
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Filing / IDR Window: 2026-11-23
[NVDOI-MRF-CPT-29881-325] Anthem Blue Cross and Blue Shield of Nevada TiC MRF Rate Disparity: Ophthalmology & Anterior Segment Cataract/MIGS ASC (CPT 66984)
Commercial payer TiC MRF negotiated rate benchmark and bilateral/MIGS multiple-procedure reduction (50% MPPR) audit for Nv Ophthalmic Ambulatory Surgery Centers (CPT 66984 Extracapsular Cataract Extraction with IOL, CPT 66991 Cataract with Anterior Segment Aqueous Drainage Device, CPT 66821 YAG Laser Capsulotomy, and CPT 65855 Trabeculoplasty) across Anthem Blue Cross Blue Shield NV & Sierra Health.
Cohort MRF 75th-Pct Value
$1,290,000
Target % of Medicare
221.0% MPFS
Statutory Authority
NV-GPCI-2026 (NRS 689A.410 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-29881 | Knee Arthroscopy, Surgical, with Meniscectomy (ASC + Pro) | CLAIM | 500 | $601.60 | $1,400.60 | $1,767.20 |
| CPT-27447 | Total Knee Arthroplasty (Condyle and Plateau) | CLAIM | 140 | $872.32 | $2,030.87 | $2,562.44 |
| 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)
Desert Orthopaedic Center Las Vegas ASCReno Orthopedic Clinic (ROC) Surgery CenterCrovetti Orthopaedics & Sports Medicine HendersonSierra Neurosurgery Group Reno NVThe Spine & Brain Institute Las Vegas