Federal IDR outcomes: Infectious disease
In 2025 Q1–Q4, the provider or facility offer prevailed in 80.2% of 1,392 determined Federal IDR dispute line items for infectious disease. The median prevailing offer was 4.87x the QPA (25th–75th percentile 2.41x–6.12x; n = 1,361). The median time to a decision was 33 business days (n = 1,392).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
1,392
2025 Q1–Q4 · 2 split decisions excluded
Provider win rate
80.2%
n = 1,392 · 2025 Q1–Q4
Median payment vs QPA
4.87x
middle half 2.41x–6.12x · n = 1,361 · 2025 Q1–Q4
Median days to decision
33
business days, from dispute initiation · n = 1,392 · 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 | 1,392 | 80.2% | 4.87x | 2.41x–6.12x | 1,361 | 33 |
| 2024 Q1–Q4 | 36 | 66.7% | 3.90x | 1.64x–4.26x | 35 | 18 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 1,429 | 79.9% | 4.87x | 2.41x–6.12x | 1,397 | 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 | 320 | 73.4% | 12.03x | 317 | 25 |
| Oklahoma | 314 | 82.5% | 4.60x | 313 | 35 |
| Texas | 253 | 94.5% | 5.73x | 231 | 41 |
| Connecticut | 132 | 82.6% | 2.41x | 131 | 40 |
| Utah | 100 | 46.0% | 1.05x | 100 | 41 |
| Louisiana | 87 | 100.0% | 5.11x | 84 | 17 |
| Minnesota | 75 | 85.3% | 4.91x | 75 | 39 |
| Ohio | 50 | 52.0% | 4.60x | 50 | 22 |
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 | 1,169 | 80.4% | 4.75x | 1,140 | 34 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 75 | 80.0% | 27.26x † | 75 | 25 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 40 | 72.5% | 6.08x | 40 | 35 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for infectious disease?
In 2025 Q1–Q4, the provider or facility offer was selected in 80.2% of 1,392 determined dispute line items for infectious disease. 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 infectious disease?
In 2025 Q1–Q4, the median prevailing offer was 4.87x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.41x to 6.12x (n = 1,361 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 infectious disease?
In 2025 Q1–Q4, the median was 33 business days (n = 1,392 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).