Federal IDR outcomes: Obstetrics and gynecology
In 2025 Q1–Q4, the provider or facility offer prevailed in 88.5% of 13,256 determined Federal IDR dispute line items for obstetrics and gynecology. The median prevailing offer was 25.45x the QPA (25th–75th percentile 5.46x–78.60x; n = 12,580). The median time to a decision was 30 business days (n = 13,256).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
13,256
2025 Q1–Q4 · 18 split decisions excluded
Provider win rate
88.5%
n = 13,256 · 2025 Q1–Q4
Median days to decision
30
business days, from dispute initiation · n = 13,256 · 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 | 13,256 | 88.5% | 25.45x † | 5.46x–78.60x | 12,580 | 30 |
| 2024 Q1–Q4 | 3,512 | 89.9% | 17.35x | 5.38x–48.31x | 3,289 | 42 |
| 2023 Q1–Q4 | 286 | 92.3% | 8.18x | 4.56x–18.36x | 286 | 29 |
| 2023 Q1–2025 Q4 | 17,054 | 88.9% | 23.07x † | 5.40x–72.43x | 16,155 | 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 | 4,688 | 90.4% | 30.65x † | 4,346 | 30 |
| New Jersey | 3,210 | 87.8% | 22.44x † | 3,061 | 29 |
| California | 2,435 | 92.3% | 45.34x † | 2,388 | 27 |
| Tennessee | 1,124 | 67.5% | 1.00x | 1,119 | 44 |
| Georgia | 702 | 94.9% | 35.29x † | 677 | 30 |
| Texas | 549 | 98.5% | 56.85x † | 492 | 39 |
| Missouri | 101 | 93.1% | 63.15x † | 95 | 20 |
| Florida | 87 | 86.2% | 39.67x † | 77 | 22 |
| Mississippi | 86 | 91.9% | 1.00x | 82 | 63.5 |
| District of Columbia | 83 | 84.3% | 36.53x † | 68 | 29 |
| Washington | 72 | 88.9% | 38.53x † | 71 | 31.5 |
| Arizona | 58 | 63.8% | 32.02x † | 55 | 22.5 |
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 |
|---|---|---|---|---|---|
| 58662 Destruction or removal of ovary or growth of pelvis using an endoscope | 1,569 | 90.9% | 46.19x † | 1,531 | 30 |
| 58558 Biopsy of lining of uterus and/or removal of polyp using an endoscope | 797 | 93.0% | 32.66x † | 787 | 30 |
| 81420 Test for detecting genes associated with fetal disease, aneuploidy genomic seque | 771 | 60.8% | 1.00x | 766 | 53 |
| 50949 Other procedure on ureter using an endoscope | 678 | 91.7% | 21.81x † | 596 | 29 |
| 45499 Other procedure on rectum using an endoscope | 599 | 91.3% | 17.77x | 531 | 28 |
| 64999 Other procedure on nervous system | 465 | 94.4% | 107.51x † | 419 | 30 |
| 59400 Vaginal delivery with care before and after delivery | 447 | 86.4% | 13.33x | 421 | 32 |
| 58999 Other procedure on female genital system (nonobstetrical) | 366 | 93.7% | 27.87x † | 332 | 28 |
| 76817 Vaginal ultrasound of pregnant uterus | 333 | 90.4% | 111.11x † | 333 | 32 |
| 58578 Other procedure on uterus using an endoscope | 287 | 93.0% | 20.16x † | 267 | 29 |
| 58571 Removal of uterus, tubes, and/or ovaries through abdomen using an endoscope, 250 | 275 | 85.5% | 31.92x † | 274 | 28 |
| 59840 Induced abortion by dilation and scraping of uterine | 274 | 88.7% | 51.42x † | 274 | 34 |
| 52260 Dilation of bladder using an endoscope under general or spinal anesthesia | 271 | 94.5% | 65.70x † | 270 | 29 |
| 51999 Other procedure on bladder using an endoscope | 254 | 95.3% | 16.65x | 228 | 29 |
| 58661 Removal of ovaries and/or tubes using an endoscope | 251 | 91.6% | 57.75x † | 240 | 28 |
| 44979 Other procedure on appendix using an endoscope | 229 | 95.6% | 26.06x † | 210 | 28 |
| 59510 Cesarean delivery with care before and after delivery | 220 | 83.6% | 14.08x | 208 | 29 |
| 44238 Other procedure on bowel using an endoscope | 208 | 93.3% | 20.38x † | 193 | 27 |
| 58545 Removal of growth of uterus using an endoscope, 250.0 g or less | 198 | 91.4% | 34.24x † | 196 | 30 |
| 45300 Diagnostic exam of rectum and lower large bowel using an endoscope | 194 | 95.4% | 217.83x † | 194 | 27 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 185 | 83.8% | 23.83x † | 164 | 25 |
| 58679 Other procedure on fallopian tube or ovary using an endoscope | 166 | 96.4% | 18.87x | 155 | 25 |
| 50715 Release of scar tissue at ureter | 141 | 92.2% | 11.39x | 115 | 35 |
| 44970 Removal of appendix using an endoscope | 137 | 94.9% | 68.99x † | 134 | 26 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 123 | 82.1% | 23.05x † | 110 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for obstetrics and gynecology?
In 2025 Q1–Q4, the provider or facility offer was selected in 88.5% of 13,256 determined dispute line items for obstetrics and gynecology. 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 obstetrics and gynecology?
In 2025 Q1–Q4, the median prevailing offer was 25.45x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 5.46x to 78.60x (n = 12,580 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 obstetrics and gynecology?
In 2025 Q1–Q4, the median was 30 business days (n = 13,256 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).