Which services and specialties are covered?
The No Surprises Act is organized around the setting of care, not a list of specialties. A specialty appears in Federal IDR when its out-of-network services fall into one of the covered situations.
Covered situations
- Emergency services at hospital emergency departments and independent freestanding emergency departments, and some post-stabilization care (45 CFR 149.110).
- Non-emergency items and services by out-of-network providers at in-network health care facilities (45 CFR 149.120).
- Air ambulance services (42 U.S.C. 300gg-112).
Services where patients cannot waive protections
At in-network facilities, the notice-and-consent exception is not available for ancillary services: items and services related to emergency medicine, anesthesiology, pathology, radiology and neonatology; services by assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and services provided when no in-network provider is available at the facility (42 U.S.C. 300gg-132(b)) (45 CFR 149.420).
Not covered by the federal process
- Medicare, Medicaid, CHIP and TRICARE coverage (CMS applicability chart).
- Ground ambulance services (some states regulate them; Texas, for example, has since January 1, 2024 (TDI)).
- Uninsured and self-pay patients, who have good faith estimate and patient-provider dispute rights instead (CMS).
- Services where a specified state law or All-Payer Model Agreement applies (see state laws).
Specialties most present in the data
Specialty groups with the most determined Federal IDR line items, 2023 Q1–2025 Q4 (CMS free-text specialty field, grouped by our rules):
| Specialty group | Determined line items | Provider win rate |
|---|---|---|
| Emergency medicine and emergency departments | 4,069,619 | 85.3% |
| Radiology | 1,569,904 | 93.3% |
| Hospitals and facilities | 733,657 | 85.2% |
| Anesthesiology | 504,370 | 84.2% |
| Not reported / unspecified | 498,605 | 51.8% |
| Intraoperative neuromonitoring | 375,419 | 87.5% |
| Hospital medicine (hospitalists) | 58,520 | 88.4% |
| General and other surgery | 56,934 | 87.3% |
Source: CMS Federal IDR public use files. See all specialties.
Common questions
Is ground ambulance covered by Federal IDR?
No. The federal surprise billing protections cover air ambulance, not ground ambulance. Some states, including Texas, have their own ground ambulance rules.
Can an anesthesiologist ask a patient to waive surprise billing protections?
Not at an in-network facility: anesthesiology is an ancillary service for which the notice-and-consent exception is not available (42 U.S.C. 300gg-132(b)).
More in Learn: The No Surprises Act, in plain English · How Federal IDR works, step by step · What is the qualifying payment amount (QPA)? · State surprise billing laws and Federal IDR (including Texas) · Federal IDR glossary
General information, not legal advice. Rules change; check the cited sources. Last reviewed 2026-10-19.