← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NY
NYDOI-MRF-CPT-29881
•
New York State Department of Financial Services (NYDFS) & NGS JK MRF Index — New York Metro MSA
•
Nassau County, NY
•
Filing / IDR Window: 2026-11-27
NY 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 NY (CPT 29881 Knee Arthroscopy & CPT 27447 Total Knee Arthroplasty).
Cohort MRF 75th-Pct Value
$1,665,000
Target % of Medicare
231.5% MPFS
Statutory Authority
NY-GPCI-2026-NYC (Medicare Locality 13202-01 & NY Ins. Law § 3224-a 12% 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 | Orthopedic & ASC: Arthroscopy, Knee, Surgical; with Meniscectomy (Medial/Lateral) & CPT 27447 Total Knee | CLAIM | 420 | $640.00 | $1,185.00 | $1,495.00 |
| CPT-52356 | Cystourethroscopy, with Ureteroscopy and/or Pyeloscopy; with Lithotripsy Including Insertion of Indwelling Ureteral Stent | CLAIM | 240 | $1,400.70 | $3,024.70 | $3,796.10 |
| CPT-50590 | Lithotripsy, Extracorporeal Shock Wave (ESWL) — Renal/Ureteral Calculus (ASC Facility + Professional) | CLAIM | 195 | $1,309.35 | $2,831.85 | $3,532.20 |
| CPT-52000 | Cystourethroscopy (Separate Procedure, Office/ASC Facility Fee & Modifier 25 E/M Unbundling Audit) | CLAIM | 510 | $248.67 | $537.95 | $685.12 |
| CPT-52601 | Transurethral Electrosurgical Resection of Prostate (TURP), Including Control of Postoperative Bleeding, Complete | CLAIM | 110 | $1,674.75 | $3,593.10 | $4,486.30 |
| CPT-63030 | Neurosurgery & Spine: Lumbar Laminotomy/Discectomy (1 Interspace) & CPT 22551 Anterior Cervical ACDF | CLAIM | 185 | $1,480.00 | $2,190.00 | $2,940.00 |
| CPT-45380 | Gastroenterology & Endoscopy ASC: Flexible Colonoscopy with Biopsy & CPT 43239 Upper GI EGD | CLAIM | 610 | $520.00 | $795.00 | $1,140.00 |
| CPT-66984 | Ophthalmology & Ophthalmic ASC: Extracapsular Cataract Removal with IOL Prosthesis & CPT 67028 | CLAIM | 540 | $680.00 | $985.00 | $1,390.00 |
| CPT-70553 | Diagnostic Radiology & Cardiology: Brain MRI w/ & w/o Contrast, CPT 74177 CT & CPT 93306 Echo | CLAIM | 480 | $410.00 | $685.00 | $995.00 |
| CPT-99285 | Emergency Medicine, Pathology & Anesthesia: Level-5 E/M, CPT 88305 Surgical Path & CPT 01402 QPA | CLAIM | 890 | $340.00 | $565.00 | $845.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Active Sports Medicine & Orthopaedic Surgery PcEckert & ZieglerManhattan Orthopedic CareMedical Billing Star