Federal IDR outcomes: Neonatology
In 2025 Q1–Q4, the provider or facility offer prevailed in 86.2% of 13,625 determined Federal IDR dispute line items for neonatology. The median prevailing offer was 2.50x the QPA (25th–75th percentile 1.56x–3.75x; n = 13,547). The median time to a decision was 47 business days (n = 13,625).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
13,625
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
86.2%
n = 13,625 · 2025 Q1–Q4
Median payment vs QPA
2.50x
middle half 1.56x–3.75x · n = 13,547 · 2025 Q1–Q4
Median days to decision
47
business days, from dispute initiation · n = 13,625 · 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 | 13,625 | 86.2% | 2.50x | 1.56x–3.75x | 13,547 | 47 |
| 2024 Q1–Q4 | 12,731 | 81.7% | 3.12x | 1.60x–5.21x | 12,723 | 190 |
| 2023 Q1–Q4 | 6,301 | 86.9% | 3.97x | 2.64x–5.79x | 6,300 | 36 |
| 2023 Q1–2025 Q4 | 32,657 | 84.6% | 3.06x | 1.67x–4.69x | 32,570 | 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 |
|---|---|---|---|---|---|
| Tennessee | 4,883 | 87.1% | 2.00x | 4,863 | 54 |
| South Carolina | 1,856 | 84.1% | 2.44x | 1,830 | 39 |
| Maryland | 1,341 | 87.2% | 4.40x | 1,340 | 39 |
| Indiana | 1,317 | 88.2% | 3.46x | 1,317 | 47 |
| Iowa | 1,051 | 78.5% | 2.41x | 1,051 | 41 |
| Oklahoma | 552 | 94.4% | 3.60x | 552 | 146.5 |
| Arkansas | 409 | 83.6% | 3.53x | 409 | 112 |
| Wisconsin | 359 | 79.1% | 2.25x | 359 | 35 |
| Maine | 352 | 86.1% | 1.65x | 331 | 57 |
| Louisiana | 311 | 88.4% | 2.01x | 311 | 128 |
| Utah | 239 | 71.1% | 2.10x | 229 | 33 |
| New York | 157 | 89.2% | 2.63x | 157 | 30 |
| New Jersey | 139 | 97.1% | 5.61x | 139 | 378 |
| Kentucky | 118 | 89.8% | 3.13x | 118 | 26 |
| Missouri | 88 | 100.0% | 3.16x | 88 | 20 |
| Kansas | 83 | 94.0% | 3.58x | 83 | 19 |
| Texas | 76 | 100.0% | 5.09x | 76 | 365.5 |
| Alaska | 75 | 74.7% | 3.06x | 75 | 33 |
| West Virginia | 55 | 92.7% | 2.80x | 55 | 35 |
| Arizona | 54 | 96.3% | 2.93x | 54 | 166 |
| Pennsylvania | 43 | 74.4% | 4.28x | 43 | 145 |
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 |
|---|---|---|---|---|---|
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 3,471 | 86.3% | 2.47x | 3,445 | 53 |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 2,668 | 87.2% | 2.18x | 2,647 | 49 |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 2,275 | 87.9% | 2.45x | 2,265 | 54 |
| 99472 Follow-up inpatient hospital critical care of infant or young child per day (29 | 1,259 | 80.3% | 3.18x | 1,249 | 57 |
| 99238 Hospital discharge day management, 30 minutes or less | 709 | 85.0% | 3.74x | 705 | 47 |
| 99468 Initial inpatient hospital critical care of newborn per day (28 days or younger) | 599 | 84.6% | 1.77x | 599 | 34 |
| 92650 Screening evaluation of brain response to sound with automated analysis | 405 | 93.1% | 1.98x | 401 | 105 |
| 99460 Initial evaluation and management of newborn per day | 379 | 88.7% | 2.49x | 378 | 57 |
| 99239 Hospital discharge day management, more than 30 minutes | 355 | 82.8% | 3.55x | 355 | 36 |
| 99478 Follow-up intensive care of recovering very low birth weight infant per day | 322 | 88.5% | 1.96x | 322 | 40 |
| 99477 Initial intensive care of newborn per day (28 days or younger) | 296 | 85.8% | 2.43x | 295 | 35 |
| 99462 Follow-up hospital care of newborn per day | 128 | 89.8% | 2.94x | 128 | 45 |
| 99291 Critical care, first 30-74 minutes | 107 | 86.0% | 4.03x | 107 | 33 |
| 99464 Physician attendance at delivery and stabilization of newborn | 80 | 97.5% | 2.77x | 79 | 45 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 76 | 84.2% | 5.50x | 76 | 39 |
| 99465 Reviving newborn at delivery | 68 | 82.4% | 2.25x | 68 | 36.5 |
| 99463 Initial inpatient hospital or birthing center same date care and discharge of ne | 61 | 77.0% | 2.45x | 61 | 62 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 57 | 93.0% | 4.70x | 57 | 40 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 52 | 86.5% | 4.54x | 52 | 31 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 41 | 68.3% | 3.38x | 41 | 35 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for neonatology?
In 2025 Q1–Q4, the provider or facility offer was selected in 86.2% of 13,625 determined dispute line items for neonatology. 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 neonatology?
In 2025 Q1–Q4, the median prevailing offer was 2.50x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.56x to 3.75x (n = 13,547 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 neonatology?
In 2025 Q1–Q4, the median was 47 business days (n = 13,625 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).