Federal IDR outcomes: Laboratory and pathology
In 2025 Q1–Q4, the provider or facility offer prevailed in 85.7% of 4,811 determined Federal IDR dispute line items for laboratory and pathology. The median prevailing offer was 1.00x the QPA (25th–75th percentile 1.00x–3.34x; n = 4,552). The median time to a decision was 41 business days (n = 4,811).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
4,811
2025 Q1–Q4 · 6 split decisions excluded
Provider win rate
85.7%
n = 4,811 · 2025 Q1–Q4
Median payment vs QPA
1.00x
middle half 1.00x–3.34x · n = 4,552 · 2025 Q1–Q4
Median days to decision
41
business days, from dispute initiation · n = 4,811 · 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 | 4,811 | 85.7% | 1.00x | 1.00x–3.34x | 4,552 | 41 |
| 2024 Q1–Q4 | 2,045 | 75.6% | 1.00x | 1.00x–2.91x | 2,028 | 101 |
| 2023 Q1–Q4 | 787 | 70.3% | 2.47x | 1.00x–4.58x | 722 | 57 |
| 2023 Q1–2025 Q4 | 7,643 | 81.4% | 1.00x | 1.00x–3.45x | 7,302 | 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 Jersey | 1,829 | 85.2% | 1.00x | 1,828 | 47 |
| Florida | 665 | 91.3% | 1.00x | 539 | 55 |
| Maryland | 654 | 80.1% | 4.02x | 654 | 40 |
| California | 456 | 75.9% | 6.14x | 454 | 25 |
| Colorado | 436 | 97.9% | 1.00x | 431 | 64 |
| Oklahoma | 198 | 96.5% | 1.00x | 84 | 35 |
| New York | 188 | 77.1% | 9.06x | 188 | 23 |
| Nevada | 92 | 97.8% | 1.00x | 91 | 48 |
| Virginia | 78 | 94.9% | 1.00x | 78 | 87 |
| Louisiana | 74 | 64.9% | 1.00x | 73 | 183 |
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 |
|---|---|---|---|---|---|
| 81420 Test for detecting genes associated with fetal disease, aneuploidy genomic seque | 1,829 | 89.9% | 1.00x | 1,748 | 53 |
| 88305 Pathology examination of tissue using a microscope, intermediate complexity | 945 | 81.3% | 4.02x | 945 | 38 |
| 88313 Special stained specimen slides to examine tissue including interpretation and r | 264 | 84.5% | 3.61x | 264 | 29 |
| 81329 Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion | 217 | 91.7% | 1.00x | 204 | 64 |
| 81220 Gene analysis (cystic fibrosis transmembrane conductance regular) common variant | 183 | 91.8% | 1.00x | 170 | 59 |
| 81443 Genomic sequence analysis panel for severe inherited conditions with sequencing | 162 | 95.1% | 1.00x | 161 | 72 |
| 88342 Special stained specimen slides to examine tissue, initial procedure | 159 | 77.4% | 3.92x | 158 | 27 |
| 0340U DNA assays for detection of minimal residual disease in cancer | 156 | 79.5% | 1.00x | 145 | 40.5 |
| 88312 Special stained specimen slides to identify organisms including interpretation a | 149 | 85.2% | 2.68x | 149 | 30 |
| 0326U Targeted genomic sequence analysis of 83 or more genes in cell free circulating | 87 | 78.2% | 1.00x | 86 | 30 |
| 81162 Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplicat | 63 | 82.5% | 1.00x | 61 | 52 |
| 80307 Testing for presence of drug, by chemistry analyzers | 62 | 100.0% | – | 0 | 33 |
| 81432 Test for detecting genes associated with inherited breast cancer-related disorde | 59 | 96.6% | 1.00x | 55 | 38 |
| 0242U Gene analysis of 55-74 genes associated with solid organ cancer in cell-free cir | 50 | 70.0% | 1.00x | 50 | 30 |
| 88364 Genetic sequencing localization, each additional procedure | 48 | 85.4% | 3.66x | 48 | 31 |
| 88365 Genetic sequencing localization, initial procedure | 48 | 85.4% | 3.91x | 48 | 31 |
| 88341 Special stained specimen slides to examine tissue, each additional procedure | 38 | 76.3% | 58.70x † | 38 | 22 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for laboratory and pathology?
In 2025 Q1–Q4, the provider or facility offer was selected in 85.7% of 4,811 determined dispute line items for laboratory and pathology. 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 laboratory and pathology?
In 2025 Q1–Q4, the median prevailing offer was 1.00x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.00x to 3.34x (n = 4,552 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 laboratory and pathology?
In 2025 Q1–Q4, the median was 41 business days (n = 4,811 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).