Federal IDR outcomes: Critical care
In 2025 Q1–Q4, the provider or facility offer prevailed in 93.0% of 1,417 determined Federal IDR dispute line items for critical care. The median prevailing offer was 10.21x the QPA (25th–75th percentile 4.09x–23.53x; n = 1,357). The median time to a decision was 25 business days (n = 1,417).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
1,417
2025 Q1–Q4 · 4 split decisions excluded
Provider win rate
93.0%
n = 1,417 · 2025 Q1–Q4
Median payment vs QPA
10.21x
middle half 4.09x–23.53x · n = 1,357 · 2025 Q1–Q4
Median days to decision
25
business days, from dispute initiation · n = 1,417 · 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 | 1,417 | 93.0% | 10.21x | 4.09x–23.53x | 1,357 | 25 |
| 2024 Q1–Q4 | 504 | 90.5% | 4.17x | 1.52x–5.53x | 481 | 171.5 |
| 2023 Q1–Q4 | 235 | 76.6% | 2.55x | 1.40x–5.54x | 230 | 41 |
| 2023 Q1–2025 Q4 | 2,156 | 90.6% | 5.54x | 2.39x–12.33x | 2,068 | 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 | 363 | 94.2% | 21.97x † | 362 | 28 |
| Tennessee | 257 | 93.0% | 11.31x | 246 | 22 |
| Texas | 192 | 95.8% | 4.78x | 178 | 25.5 |
| Nevada | 178 | 88.2% | 23.91x † | 178 | 28 |
| Florida | 176 | 94.3% | 4.28x | 153 | 24 |
| New Jersey | 88 | 96.6% | 27.45x † | 86 | 26 |
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 |
|---|---|---|---|---|---|
| 99291 Critical care, first 30-74 minutes | 169 | 86.4% | 7.41x | 160 | 24 |
| 99190 Assembly and operation of heart-lung machine, each hour | 131 | 96.9% | 4.08x | 111 | 24 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 113 | 92.9% | 9.06x | 113 | 28 |
| 99292 Critical care, each additional 30 minutes | 112 | 92.0% | 12.33x | 108 | 22 |
| 33948 Daily management of ECMO external vein to vein blood circulation in heart and lu | 83 | 94.0% | 11.40x | 78 | 24 |
| 99191 Assembly and operation of heart-lung machine, 45 minutes | 82 | 96.3% | 4.16x | 81 | 24 |
| 86891 Processing and storage of blood unit or component, intra- or postoperative salva | 65 | 96.9% | 11.16x | 64 | 24 |
| 99192 Assembly and operation of heart-lung machine, 30 minutes | 58 | 94.8% | 3.83x | 57 | 22.5 |
| 47562 Removal of gallbladder using an endoscope | 34 | 94.1% | 48.33x † | 34 | 26.5 |
| 33949 Daily management of ECMO external vein to artery blood circulation in heart and | 30 | 93.3% | – | 27 | 21 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for critical care?
In 2025 Q1–Q4, the provider or facility offer was selected in 93.0% of 1,417 determined dispute line items for critical care. 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 critical care?
In 2025 Q1–Q4, the median prevailing offer was 10.21x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 4.09x to 23.53x (n = 1,357 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 critical care?
In 2025 Q1–Q4, the median was 25 business days (n = 1,417 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).