Federal IDR outcomes: Internal and family medicine
In 2025 Q1–Q4, the provider or facility offer prevailed in 86.1% of 25,299 determined Federal IDR dispute line items for internal and family medicine. The median prevailing offer was 6.44x the QPA (25th–75th percentile 3.11x–10.73x; n = 24,590). The median time to a decision was 32 business days (n = 25,299).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
25,299
2025 Q1–Q4 · 76 split decisions excluded
Provider win rate
86.1%
n = 25,299 · 2025 Q1–Q4
Median payment vs QPA
6.44x
middle half 3.11x–10.73x · n = 24,590 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 25,299 · 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 | 25,299 | 86.1% | 6.44x | 3.11x–10.73x | 24,590 | 32 |
| 2024 Q1–Q4 | 2,620 | 76.3% | 8.37x | 2.45x–12.13x | 2,564 | 39 |
| 2023 Q1–Q4 | 45 | 75.6% | 3.97x | 2.82x–3.97x | 45 | 141 |
| 2023 Q1–2025 Q4 | 27,964 | 85.2% | 6.59x | 3.09x–10.98x | 27,199 | 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 | 6,127 | 87.0% | 6.23x | 6,100 | 27 |
| Texas | 5,491 | 93.7% | 5.48x | 5,023 | 29 |
| Missouri | 2,811 | 79.2% | 7.86x | 2,803 | 43 |
| New York | 2,472 | 82.3% | 10.23x | 2,469 | 32 |
| Arizona | 1,309 | 77.6% | 8.27x | 1,307 | 34 |
| Maryland | 1,298 | 89.8% | 7.14x | 1,296 | 34 |
| Indiana | 1,042 | 85.8% | 6.80x | 884 | 39.5 |
| New Jersey | 723 | 66.5% | 3.21x | 700 | 29 |
| Georgia | 615 | 84.4% | 5.30x | 614 | 44 |
| Virginia | 271 | 84.9% | 5.48x | 269 | 47 |
| Louisiana | 268 | 73.9% | 9.14x | 267 | 37 |
| Oklahoma | 258 | 97.7% | 10.85x | 251 | 30 |
| Florida | 256 | 83.6% | 8.22x | 256 | 52 |
| Ohio | 220 | 91.4% | 8.24x | 220 | 27 |
| New Mexico | 216 | 98.1% | 9.67x | 212 | 37 |
| Nevada | 208 | 86.1% | 5.30x | 208 | 28.5 |
| Tennessee | 194 | 83.5% | 6.00x | 194 | 84 |
| Arkansas | 168 | 74.4% | 6.36x | 168 | 33.5 |
| Montana | 150 | 84.0% | 4.46x | 150 | 44 |
| Illinois | 130 | 91.5% | 6.48x | 130 | 65 |
| Iowa | 126 | 93.7% | 5.50x | 125 | 27 |
| Washington | 105 | 92.4% | 3.61x | 105 | 36 |
| Kansas | 104 | 93.3% | 8.68x | 103 | 32.5 |
| Oregon | 94 | 74.5% | 2.34x | 94 | 32 |
| Michigan | 88 | 95.5% | 5.76x | 88 | 42.5 |
| South Carolina | 84 | 81.0% | 5.94x | 84 | 36.5 |
| Wyoming | 52 | 94.2% | 2.62x | 52 | 88 |
| North Carolina | 51 | 88.2% | 4.66x | 51 | 37 |
| Wisconsin | 48 | 95.8% | 4.37x | 48 | 23 |
| Alabama | 43 | 86.0% | 6.86x | 43 | 40 |
| Idaho | 42 | 90.5% | 7.08x | 42 | 18 |
| Massachusetts | 40 | 95.0% | 6.50x | 40 | 24 |
| Colorado | 34 | 70.6% | 5.72x | 34 | 27.5 |
| West Virginia | 34 | 97.1% | 11.65x | 34 | 65 |
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 | 4,970 | 83.4% | 6.24x | 4,883 | 33 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 3,431 | 84.0% | 7.16x | 3,254 | 33 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 3,309 | 86.6% | 7.14x | 3,227 | 31 |
| 99291 Critical care, first 30-74 minutes | 2,828 | 89.2% | 5.76x | 2,806 | 32 |
| 99239 Hospital discharge day management, more than 30 minutes | 2,668 | 84.5% | 6.00x | 2,610 | 33 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 1,572 | 87.4% | 5.21x | 1,536 | 30 |
| 99238 Hospital discharge day management, 30 minutes or less | 800 | 90.1% | 6.61x | 773 | 27 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 533 | 91.7% | 7.49x | 529 | 33 |
| 99284 Emergency department visit with moderate level of medical decision making | 312 | 88.5% | 9.97x | 312 | 40 |
| 99497 Advance care planning, first 30 minutes | 255 | 82.0% | 5.87x | 251 | 43 |
| 99285 Emergency department visit with high level of medical decision making | 250 | 92.4% | 12.26x | 244 | 37.5 |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 249 | 83.9% | 39.02x † | 240 | 35 |
| 99235 Initial hospital care with same-day admission and discharge with moderate level | 226 | 90.3% | 2.95x | 224 | 24 |
| 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscop | 220 | 89.5% | 104.23x † | 218 | 24 |
| 99236 Initial hospital care with same-day admission and discharge with high level of m | 217 | 87.6% | 2.04x | 216 | 27 |
| 45380 Biopsy of large bowel using a flexible endoscope | 141 | 89.4% | 60.41x † | 138 | 25 |
| 99418 Prolonged inpatient or observation service, each 15 minutes of total time beyond | 134 | 88.8% | 1.00x | 134 | 36.5 |
| 99283 Emergency department visit with low level of medical decision making | 129 | 83.7% | 13.85x | 129 | 30 |
| 99292 Critical care, each additional 30 minutes | 109 | 89.9% | 5.56x | 109 | 37 |
| 99221 Initial hospital care with straightforward or low level of medical decision maki | 85 | 83.5% | 11.28x | 85 | 31 |
| 45385 Removal of polyps or growths of large bowel using an endoscope with mechanical s | 71 | 88.7% | 41.90x † | 71 | 26 |
| 31500 Emergent insertion of breathing tube into windpipe using an endoscope | 68 | 85.3% | 5.93x | 68 | 37 |
| 36556 Insertion of non-tunneled central venous tube for infusion (5 years or older) | 68 | 88.2% | 5.02x | 67 | 50 |
| 00840 Anesthesia for other procedure on lower abdomen | 52 | 86.5% | 4.94x | 52 | 24.5 |
| 45378 Diagnostic exam of large bowel using a flexible endoscope | 46 | 80.4% | 59.48x † | 46 | 26 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for internal and family medicine?
In 2025 Q1–Q4, the provider or facility offer was selected in 86.1% of 25,299 determined dispute line items for internal and family medicine. 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 internal and family medicine?
In 2025 Q1–Q4, the median prevailing offer was 6.44x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 3.11x to 10.73x (n = 24,590 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 internal and family medicine?
In 2025 Q1–Q4, the median was 32 business days (n = 25,299 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).