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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
OH
OHDOI-MRF-CPT-29881
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Ohio Department of Insurance (ODI) & CGS J15 MRF Index — Columbus / Cleveland MSA
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Franklin County, OH
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Filing / IDR Window: 2026-12-02
OH Commercial Payer TiC MRF & Federal NSA IDR Cohort — Multi-Specialty RCM
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 Multi-Specialty Surgical, ASC & E/M in OH (CPT 29881 Arthroscopy, CPT 45380 Endoscopy & CPT 99285 High-Severity E/M).
Cohort MRF 75th-Pct Value
$1,920,000
Target % of Medicare
249.0% MPFS
Statutory Authority
OH-GPCI-2026-CMH (Medicare Locality 15202-00 & O.R.C. § 3901.389 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 | Orthopedic & ASC: Arthroscopy, Knee, Surgical; with Meniscectomy (Medial/Lateral) & CPT 27447 Total Knee | CLAIM | 420 | $640.00 | $1,185.00 | $1,495.00 |
| CPT-63030 | Laminotomy (Hemilaminectomy), with Decompression of Nerve Root(s), Including Partial Facetectomy, Lumbar | CLAIM | 270 | $2,031.75 | $4,429.00 | $5,676.00 |
| CPT-22551 | Arthrodesis, Anterior Interbody, Including Disc Space Preparation, Discectomy, Osteophytectomy, Cervical Below C2 | CLAIM | 175 | $3,923.75 | $8,428.00 | $10,416.75 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
EnableComp SpecialtyEnsemble Health PartnersManaged Care Advisory GroupPremier Physician Network Dayton