Federal IDR outcomes: Gastroenterology
In 2025 Q1–Q4, the provider or facility offer prevailed in 83.6% of 2,255 determined Federal IDR dispute line items for gastroenterology. The median prevailing offer was 22.77x the QPA (25th–75th percentile 7.68x–53.39x; n = 2,234). The median time to a decision was 30 business days (n = 2,255).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
2,255
2025 Q1–Q4 · 2 split decisions excluded
Provider win rate
83.6%
n = 2,255 · 2025 Q1–Q4
Median days to decision
30
business days, from dispute initiation · n = 2,255 · 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 | 2,255 | 83.6% | 22.77x † | 7.68x–53.39x | 2,234 | 30 |
| 2024 Q1–Q4 | 118 | 88.1% | 37.35x † | 16.18x–59.34x | 116 | 32 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 2,377 | 83.9% | 23.81x † | 7.82x–53.66x | 2,354 | 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 | 1,230 | 78.9% | 11.94x | 1,212 | 31.5 |
| California | 984 | 89.7% | 54.37x † | 984 | 27 |
| New Jersey | 30 | 70.0% | – | 29 | 36 |
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 |
|---|---|---|---|---|---|
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 752 | 82.3% | 17.37x | 742 | 33.5 |
| 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscop | 281 | 88.6% | 84.00x † | 281 | 26 |
| 45380 Biopsy of large bowel using a flexible endoscope | 212 | 86.3% | 55.67x † | 212 | 26 |
| 99497 Advance care planning, first 30 minutes | 172 | 80.8% | 7.33x | 169 | 32.5 |
| 45385 Removal of polyps or growths of large bowel using an endoscope with mechanical s | 131 | 90.8% | 36.36x † | 131 | 27 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 124 | 79.0% | 11.37x | 122 | 34.5 |
| 45378 Diagnostic exam of large bowel using a flexible endoscope | 81 | 88.9% | 41.02x † | 81 | 24 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 61 | 68.9% | 20.59x † | 61 | 24 |
| 99285 Emergency department visit with high level of medical decision making | 50 | 90.0% | 22.42x † | 48 | 30.5 |
| 43251 Removal of polyps or growths of esophagus, stomach, and/or upper small bowel usi | 49 | 81.6% | 73.13x † | 49 | 23 |
| 99255 Hospital consultation with high level of medical decision making, if using time, | 48 | 70.8% | 6.40x | 46 | 27.5 |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 39 | 94.9% | 91.85x † | 39 | 35 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for gastroenterology?
In 2025 Q1–Q4, the provider or facility offer was selected in 83.6% of 2,255 determined dispute line items for gastroenterology. 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 gastroenterology?
In 2025 Q1–Q4, the median prevailing offer was 22.77x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 7.68x to 53.39x (n = 2,234 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 gastroenterology?
In 2025 Q1–Q4, the median was 30 business days (n = 2,255 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).