CPT 86756: Federal IDR outcomes
Analysis for antibody to respiratory syncytial virus (RSV)
In 2025 Q1–Q4, the provider or facility offer prevailed in 81.7% of 60 determined Federal IDR dispute line items for CPT 86756. The median time to a decision was 33 business days (n = 60).
Determined line items
60
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
81.7%
n = 60 · 2025 Q1–Q4
Median payment vs QPA
–
n = 8, below 30 · 2025 Q1–Q4
Median days to decision
33
business days, from dispute initiation · n = 60 · 2025 Q1–Q4
Dollar amounts
Fewer than 30 line items with dollar amounts in 2025 Q1–Q4; not shown.
Dollar amounts by period
| Period | Line items with $ | Total awarded | Total QPA | Above QPA | Median award | Median QPA | Award ×QPA ($-weighted) |
|---|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2024 Q3–Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2024 Q3–2025 Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2023 Q1–2024 Q2 | Not available (see methodology). | ||||||
From the CMS QPA and Offers file (see above). Award ×QPA here is total awarded ÷ total QPA, so large claims weigh more than in the per-line median ratio.
By period
| Period | Line items | Win % | Median ×QPA | 25th–75th | Ratio n | Median days |
|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | 60 | 81.7% | – | – | 8 | 33 |
| 2024 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 63 | 82.5% | – | – | 9 | not pooled |
Line items = determined dispute line items (n). Win rate excludes split decisions and includes default decisions. Ratio n = line items reporting a payment-to-QPA ratio. Days are business days as reported by CMS (2023–2024: from IDR entity assignment; 2025: from initiation) and are never pooled.
By state
| State (place of service) | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Texas | 60 | 81.7% | – | 8 | 33 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
By specialty
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Not reported / unspecified | 51 | 82.4% | – | 0 | 33 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Section: Pathology and laboratory (80047–89398)
FAQ
What is the Federal IDR provider win rate for CPT 86756?
In 2025 Q1–Q4, the provider or facility offer was selected in 81.7% of 60 determined dispute line items for CPT 86756. Split decisions are excluded from the denominator and default decisions are included. Withdrawn, settled and ineligible disputes are not in the CMS data.
How long do Federal IDR decisions take for CPT 86756?
In 2025 Q1–Q4, the median was 33 business days (n = 60 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).