Federal IDR outcomes: Emergency medicine and emergency departments
In 2025 Q1–Q4, the provider or facility offer prevailed in 86.1% of 3,003,103 determined Federal IDR dispute line items for emergency medicine and emergency departments. The median prevailing offer was 3.70x the QPA (25th–75th percentile 2.09x–7.11x; n = 2,588,691). The median time to a decision was 32 business days (n = 3,003,103).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
3,003,103
2025 Q1–Q4 · 2,663 split decisions excluded
Provider win rate
86.1%
n = 3,003,103 · 2025 Q1–Q4
Median payment vs QPA
3.70x
middle half 2.09x–7.11x · n = 2,588,691 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 3,003,103 · 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 | 3,003,103 | 86.1% | 3.70x | 2.09x–7.11x | 2,588,691 | 32 |
| 2024 Q1–Q4 | 921,631 | 83.0% | 3.01x | 1.82x–4.61x | 755,378 | 88 |
| 2023 Q1–Q4 | 144,885 | 83.4% | 2.55x | 1.65x–3.53x | 130,393 | 77 |
| 2023 Q1–2025 Q4 | 4,069,619 | 85.3% | 3.44x | 2.00x–6.21x | 3,474,462 | 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 | 1,540,380 | 85.2% | 4.76x | 1,257,518 | 29 |
| Arizona | 177,255 | 82.7% | 3.42x | 132,797 | 41 |
| Florida | 151,211 | 89.0% | 2.10x | 138,341 | 40 |
| Georgia | 110,650 | 88.4% | 2.97x | 93,441 | 42 |
| Oklahoma | 90,054 | 93.4% | 5.64x | 87,201 | 33 |
| Tennessee | 87,652 | 82.9% | 3.16x | 83,719 | 45 |
| Arkansas | 83,817 | 88.5% | 5.20x | 83,449 | 34 |
| Indiana | 68,819 | 86.6% | 2.94x | 67,941 | 31 |
| Louisiana | 68,442 | 77.2% | 3.85x | 67,595 | 31 |
| New Mexico | 60,272 | 94.0% | 5.21x | 58,469 | 32 |
| California | 57,846 | 89.9% | 2.64x | 52,857 | 30 |
| Virginia | 54,185 | 85.6% | 3.04x | 51,493 | 49 |
| Nevada | 53,397 | 90.5% | 2.66x | 43,715 | 37 |
| Ohio | 44,247 | 91.5% | 2.44x | 43,303 | 38 |
| New York | 34,765 | 88.2% | 2.52x | 27,152 | 46 |
| Alabama | 32,481 | 84.8% | 5.28x | 31,625 | 48 |
| North Carolina | 31,645 | 83.4% | 2.70x | 28,961 | 35 |
| South Carolina | 27,933 | 87.8% | 3.05x | 27,710 | 43 |
| Missouri | 27,051 | 90.4% | 3.98x | 26,144 | 41 |
| Kansas | 24,988 | 94.2% | 3.50x | 24,464 | 28 |
| New Jersey | 23,259 | 86.1% | 2.12x | 17,099 | 48 |
| Kentucky | 19,961 | 90.8% | 3.40x | 18,687 | 45 |
| Mississippi | 17,901 | 86.5% | 3.97x | 17,680 | 34 |
| Illinois | 17,615 | 86.1% | 3.36x | 16,055 | 37 |
| Maryland | 13,345 | 82.5% | 3.27x | 13,218 | 42 |
| Washington | 12,274 | 90.6% | 2.30x | 12,034 | 29 |
| Wisconsin | 12,223 | 81.4% | 2.30x | 10,891 | 30 |
| Michigan | 11,519 | 89.8% | 3.15x | 9,244 | 35 |
| Idaho | 7,209 | 82.2% | 8.34x | 7,198 | 21 |
| Connecticut | 6,990 | 79.7% | 2.95x | 6,636 | 36 |
| Pennsylvania | 6,199 | 88.9% | 3.12x | 6,030 | 45 |
| Colorado | 4,574 | 88.0% | 2.32x | 4,556 | 30 |
| Massachusetts | 3,602 | 69.5% | 2.13x | 3,405 | 49 |
| Iowa | 3,453 | 80.5% | 3.02x | 3,320 | 33 |
| New Hampshire | 2,639 | 93.1% | 3.17x | 2,543 | 57 |
| Rhode Island | 2,069 | 81.3% | 2.57x | 2,069 | 34 |
| West Virginia | 1,958 | 91.2% | 3.86x | 1,925 | 56 |
| Delaware | 1,880 | 72.6% | 2.06x | 1,843 | 185 |
| Maine | 1,746 | 93.8% | 2.98x | 1,735 | 27 |
| Utah | 1,669 | 81.2% | 2.33x | 1,633 | 34 |
| Nebraska | 1,282 | 80.6% | 2.69x | 783 | 34 |
| Oregon | 774 | 60.3% | 1.52x | 750 | 69.5 |
| Alaska | 571 | 84.8% | 3.26x | 206 | 24 |
| Hawaii | 504 | 84.3% | 6.10x | 504 | 26 |
| Minnesota | 417 | 88.5% | 3.46x | 376 | 44 |
| District of Columbia | 222 | 70.3% | 2.50x | 222 | 25 |
| North Dakota | 76 | 75.0% | 3.22x | 76 | 84 |
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 |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 961,044 | 86.6% | 3.40x | 886,160 | 35 |
| 99285 Emergency department visit with high level of medical decision making | 541,643 | 86.6% | 2.94x | 485,395 | 38 |
| 99283 Emergency department visit with low level of medical decision making | 249,721 | 85.4% | 3.93x | 233,561 | 29 |
| 99291 Critical care, first 30-74 minutes | 67,546 | 88.1% | 3.33x | 58,922 | 34 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 54,798 | 86.5% | 5.37x | 43,574 | 32 |
| 80053 Blood test, comprehensive group of blood chemicals | 45,249 | 86.7% | 5.29x | 37,101 | 31 |
| 81003 Automated urinalysis test | 35,441 | 85.3% | 6.55x | 28,469 | 29 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 35,227 | 89.0% | 6.26x | 25,757 | 30 |
| 96375 Injection of additional new drug or substance into vein | 32,605 | 88.2% | 5.74x | 26,113 | 32 |
| 96361 Infusion into a vein for hydration, each additional hour | 28,313 | 87.6% | 4.98x | 22,707 | 30 |
| 96374 Injection of drug or substance into vein | 27,551 | 86.6% | 4.27x | 21,894 | 30 |
| 71046 X-ray of chest, 2 views | 24,114 | 85.6% | 6.37x | 20,902 | 30 |
| 87880 Detection test by immunoassay with direct visual observation for Streptococcus, | 22,540 | 85.9% | 3.92x | 18,801 | 30 |
| 96372 Injection of drug or substance under skin or into muscle | 22,254 | 85.2% | 4.74x | 16,815 | 28 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 20,766 | 86.4% | 4.91x | 16,830 | 31 |
| 74177 CT scan of abdomen and pelvis with contrast | 20,207 | 83.6% | 6.01x | 17,759 | 30 |
| 84484 Troponin (protein) analysis, quantitative | 17,341 | 86.0% | 5.84x | 13,454 | 30 |
| 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 17,285 | 88.9% | 3.91x | 14,098 | 32 |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 15,654 | 88.2% | 3.82x | 13,893 | 32 |
| 82150 Amylase (enzyme) level | 14,635 | 84.8% | 6.47x | 11,380 | 29 |
| 82977 Glutamyltransferase (liver enzyme) level | 12,740 | 85.0% | 5.35x | 10,252 | 30 |
| 84703 Gonadotropin (reproductive hormone) analysis | 12,096 | 85.0% | 4.92x | 8,835 | 33 |
| 87426 Detection test by immunoassay technique for severe acute respiratory syndrome co | 11,885 | 91.0% | 3.37x | 11,021 | 38 |
| 81025 Urine pregnancy test | 11,812 | 86.0% | 4.53x | 10,388 | 29 |
| 74176 CT scan of abdomen and pelvis without contrast | 11,616 | 83.5% | 6.25x | 10,030 | 29 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for emergency medicine and emergency departments?
In 2025 Q1–Q4, the provider or facility offer was selected in 86.1% of 3,003,103 determined dispute line items for emergency medicine and emergency departments. 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 emergency medicine and emergency departments?
In 2025 Q1–Q4, the median prevailing offer was 3.70x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.09x to 7.11x (n = 2,588,691 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 emergency medicine and emergency departments?
In 2025 Q1–Q4, the median was 32 business days (n = 3,003,103 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).