Federal IDR outcomes: Cardiology
In 2025 Q1–Q4, the provider or facility offer prevailed in 81.2% of 2,051 determined Federal IDR dispute line items for cardiology. The median prevailing offer was 8.80x the QPA (25th–75th percentile 3.88x–31.95x; n = 2,023). The median time to a decision was 38 business days (n = 2,051).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
2,051
2025 Q1–Q4 · 6 split decisions excluded
Provider win rate
81.2%
n = 2,051 · 2025 Q1–Q4
Median payment vs QPA
8.80x
middle half 3.88x–31.95x · n = 2,023 · 2025 Q1–Q4
Median days to decision
38
business days, from dispute initiation · n = 2,051 · 2025 Q1–Q4
Dollar amounts are not shown for specialty groups: the CMS QPA and Offers file, the only source of dollar figures, has no specialty field. See methodology.
By period
| Period | Line items | Win % | Median ×QPA | 25th–75th | Ratio n | Median days |
|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | 2,051 | 81.2% | 8.80x | 3.88x–31.95x | 2,023 | 38 |
| 2024 Q1–Q4 | 854 | 84.2% | 10.62x | 4.48x–23.52x | 828 | 38 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 2,918 | 82.1% | 9.03x | 4.14x–29.44x | 2,864 | 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 |
|---|---|---|---|---|---|
| New York | 1,076 | 75.8% | 5.40x | 1,070 | 53 |
| New Jersey | 756 | 91.1% | 44.76x † | 745 | 33 |
| Florida | 157 | 78.3% | 2.82x | 156 | 30 |
| California | 35 | 68.6% | 511.70x † | 35 | 19 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 405 | 67.9% | 3.98x | 405 | 41 |
| 99291 Critical care, first 30-74 minutes | 344 | 89.5% | 20.42x † | 339 | 35 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 102 | 77.5% | 17.20x | 101 | 33 |
| 93623 Programming of heart rhythm stimulation after drug infusion | 93 | 86.0% | 6.16x | 92 | 72 |
| 93657 Destruction of tissue of upper heart chamber through tube to treat abnormal hear | 75 | 88.0% | 9.03x | 75 | 69 |
| 92960 External shock to heart to regulate heart beat | 63 | 79.4% | 10.00x | 61 | 47 |
| 93655 Insertion of catheters and destruction of tissue to treat abnormal heart rhythm | 61 | 80.3% | 8.80x | 61 | 65 |
| 93656 Comprehensive electrophysiologic evaluation with catheter destruction of abnorma | 60 | 81.7% | 12.42x | 60 | 68 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 59 | 78.0% | 3.23x | 59 | 31 |
| 93622 Insertion of catheters for recording and pacing of left lower heart chamber rhyt | 52 | 80.8% | 10.34x | 52 | 62.5 |
| 93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis | 40 | 95.0% | 113.22x † | 39 | 39 |
| 99152 Use of a drug to induce depression of consciousness by physician performing a pr | 34 | 88.2% | 337.21x † | 34 | 34.5 |
| 93620 Insertion of catheters for recording and pacing of right heart chambers rhythm a | 30 | 90.0% | 7.04x | 30 | 108.5 |
| 93653 Comprehensive electrophysiologic evaluation with catheter destruction of abnorma | 30 | 96.7% | 12.06x | 30 | 79.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for cardiology?
In 2025 Q1–Q4, the provider or facility offer was selected in 81.2% of 2,051 determined dispute line items for cardiology. Split decisions are excluded from the denominator and default decisions are included. Withdrawn, settled and ineligible disputes are not in the CMS data.
How do Federal IDR payments compare with the QPA for cardiology?
In 2025 Q1–Q4, the median prevailing offer was 8.80x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 3.88x to 31.95x (n = 2,023 line items). This uses the CMS field Prevailing Party Offer as % of QPA, where 1.00x equals the QPA.
How long do Federal IDR decisions take for cardiology?
In 2025 Q1–Q4, the median was 38 business days (n = 2,051 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).