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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
VT
VTDOI-MRF-CPT-63030-346
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Vermont Department of Financial Regulation (DFR) & CMS TiC Payer MRF Index
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Chittenden County, VT
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Filing / IDR Window: 2026-11-24
[VTDOI-MRF-CPT-63030-346] Vermont UHC, Anthem & BCBS-VT Commercial MRF Rate Disparity & NSA IDR Benchmark (CPT 63030 / 22551 Spine & Neurosurgery Laminotomy)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for CPT 63030 / 22551 Spine & Neurosurgery Laminotomy in Vermont (18 V.S.A. § 9418 (12% Prompt-Pay)).
Cohort MRF 75th-Pct Value
$2,160,000
Target % of Medicare
195.0% MPFS
Statutory Authority
VT-GPCI-2026 (18 V.S.A. § 9418 (12% Prompt-Pay))
ERISA / Timely-Filing Window
425 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-63030 | Lumbar Laminotomy (Hemilaminectomy) with Decompression | CLAIM | 380 | $1,710.80 | $4,032.60 | $5,094.80 |
| CPT-22551 | Anterior Cervical Discectomy & Interbody Fusion (ACDF) | CLAIM | 165 | $2,480.66 | $5,847.27 | $7,387.46 |
| 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)
Vermont Specialty Surgical AssociatesVermont Ambulatory Surgery Center LLCRegional Medical Group of VermontVermont Physician Billing & RCM Partners