Federal IDR outcomes: Hospitals and facilities
In 2025 Q1–Q4, the provider or facility offer prevailed in 86.7% of 535,705 determined Federal IDR dispute line items for hospitals and facilities. The median prevailing offer was 2.71x the QPA (25th–75th percentile 1.45x–4.32x; n = 318,765). The median time to a decision was 39 business days (n = 535,705).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
535,705
2025 Q1–Q4 · 502 split decisions excluded
Provider win rate
86.7%
n = 535,705 · 2025 Q1–Q4
Median payment vs QPA
2.71x
middle half 1.45x–4.32x · n = 318,765 · 2025 Q1–Q4
Median days to decision
39
business days, from dispute initiation · n = 535,705 · 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 | 535,705 | 86.7% | 2.71x | 1.45x–4.32x | 318,765 | 39 |
| 2024 Q1–Q4 | 188,696 | 82.2% | 2.58x | 1.25x–4.28x | 110,893 | 64 |
| 2023 Q1–Q4 | 9,256 | 59.3% | 1.69x | 1.05x–2.97x | 8,245 | 80 |
| 2023 Q1–2025 Q4 | 733,657 | 85.2% | 2.67x | 1.34x–4.28x | 437,903 | 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 |
|---|---|---|---|---|---|
| California | 111,748 | 89.6% | 2.07x | 59,072 | 44 |
| Tennessee | 91,201 | 86.0% | 2.82x | 62,835 | 46 |
| Texas | 83,292 | 87.3% | 3.22x | 71,585 | 36 |
| Arizona | 47,943 | 76.7% | 3.00x | 4,382 | 24 |
| Mississippi | 44,611 | 86.8% | 2.73x | 37,979 | 41 |
| Pennsylvania | 21,362 | 94.3% | 3.20x | 5,840 | 35 |
| Michigan | 19,304 | 94.9% | 3.22x | 6,548 | 36 |
| Georgia | 19,290 | 86.2% | 2.60x | 8,568 | 25 |
| Missouri | 17,246 | 89.9% | 3.40x | 12,079 | 55 |
| New Jersey | 12,812 | 95.2% | 3.01x | 5,307 | 41 |
| Florida | 11,964 | 63.4% | 1.00x | 9,481 | 45 |
| Alabama | 10,324 | 93.2% | 3.29x | 7,892 | 28 |
| Nevada | 10,178 | 97.2% | 2.12x | 4,399 | 42 |
| Arkansas | 7,221 | 87.8% | 3.12x | 5,004 | 59 |
| Kansas | 6,615 | 88.5% | 2.56x | 4,560 | 42 |
| Oklahoma | 5,888 | 85.2% | 3.69x | 1,910 | 24 |
| Colorado | 4,745 | 43.5% | 1.00x | 4,698 | 93 |
| Rhode Island | 2,589 | 91.0% | 3.02x | 1,447 | 40 |
| Ohio | 2,369 | 94.3% | 3.28x | 887 | 38 |
| South Carolina | 788 | 76.8% | 2.41x | 733 | 28 |
| Indiana | 755 | 85.7% | 1.82x | 330 | 68 |
| Louisiana | 464 | 86.6% | 1.00x | 453 | 20 |
| New Hampshire | 458 | 85.4% | 3.49x | 456 | 39.5 |
| North Carolina | 408 | 50.5% | 1.00x | 386 | 34 |
| New York | 402 | 53.5% | 1.00x | 339 | 32 |
| Utah | 258 | 84.5% | 4.47x | 253 | 41.5 |
| Illinois | 257 | 67.7% | 1.41x | 213 | 25 |
| Kentucky | 250 | 92.8% | 3.72x | 242 | 28 |
| Connecticut | 212 | 100.0% | 3.63x | 202 | 49 |
| Minnesota | 191 | 77.0% | 3.81x | 158 | 42 |
| Massachusetts | 102 | 99.0% | 1.12x | 79 | 82 |
| Wisconsin | 88 | 83.0% | 1.00x | 88 | 27 |
| Alaska | 87 | 79.3% | 2.22x | 86 | 47 |
| Oregon | 78 | 88.5% | 2.13x | 78 | 52.5 |
| District of Columbia | 75 | 84.0% | 2.28x | 75 | 33 |
| Wyoming | 41 | 68.3% | 4.36x | 38 | 104 |
| Washington | 30 | 70.0% | 1.72x | 30 | 41 |
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 |
|---|---|---|---|---|---|
| 99285 Emergency department visit with high level of medical decision making | 30,101 | 84.1% | 2.54x | 23,794 | 37 |
| 99284 Emergency department visit with moderate level of medical decision making | 26,893 | 83.5% | 2.85x | 22,386 | 34 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 26,665 | 86.4% | 2.93x | 15,063 | 39 |
| 36415 Insertion of needle into vein for collection of blood sample | 21,326 | 90.7% | 2.93x | 8,086 | 44 |
| 80053 Blood test, comprehensive group of blood chemicals | 20,412 | 85.5% | 5.12x | 11,818 | 40 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 14,728 | 88.3% | 2.61x | 8,703 | 40 |
| 84484 Troponin (protein) analysis, quantitative | 14,267 | 86.0% | 2.81x | 8,600 | 39 |
| 99283 Emergency department visit with low level of medical decision making | 12,873 | 78.1% | 2.72x | 8,923 | 29 |
| 81001 Manual urinalysis test with examination using microscope, automated | 10,938 | 87.3% | 3.64x | 6,568 | 39 |
| 96374 Injection of drug or substance into vein | 10,678 | 87.1% | 2.32x | 5,640 | 42 |
| 71045 X-ray of chest, 1 view | 9,834 | 88.6% | 2.61x | 6,859 | 40 |
| 83690 Lipase (fat enzyme) level | 9,565 | 85.8% | 3.54x | 5,167 | 39 |
| 96375 Injection of additional new drug or substance into vein | 9,265 | 86.4% | 2.67x | 4,268 | 39 |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 8,705 | 88.8% | 3.04x | 4,921 | 37 |
| 96361 Infusion into a vein for hydration, each additional hour | 8,241 | 86.5% | 2.56x | 4,050 | 41 |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 6,929 | 87.7% | 3.04x | 4,749 | 45 |
| 96372 Injection of drug or substance under skin or into muscle | 6,267 | 89.3% | 2.60x | 2,535 | 39 |
| 81025 Urine pregnancy test | 6,176 | 88.0% | 3.68x | 3,116 | 39 |
| 83735 Magnesium level | 6,031 | 85.2% | 4.51x | 3,360 | 36 |
| 70450 CT scan head or brain without contrast | 5,923 | 86.7% | 3.55x | 4,092 | 40 |
| 74177 CT scan of abdomen and pelvis with contrast | 5,627 | 84.3% | 3.78x | 3,903 | 40 |
| 81003 Automated urinalysis test | 5,049 | 85.2% | 2.94x | 2,064 | 36 |
| 87086 Bacterial colony count, urine | 3,823 | 87.9% | 3.65x | 2,100 | 38 |
| 83605 Lactic acid level | 3,806 | 84.9% | 3.52x | 1,821 | 35 |
| 85610 Blood test, clotting time | 3,651 | 87.2% | 3.78x | 1,719 | 36 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for hospitals and facilities?
In 2025 Q1–Q4, the provider or facility offer was selected in 86.7% of 535,705 determined dispute line items for hospitals and facilities. 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 hospitals and facilities?
In 2025 Q1–Q4, the median prevailing offer was 2.71x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.45x to 4.32x (n = 318,765 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 hospitals and facilities?
In 2025 Q1–Q4, the median was 39 business days (n = 535,705 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).