Federal IDR outcomes: Pain medicine
In 2025 Q1–Q4, the provider or facility offer prevailed in 85.5% of 18,979 determined Federal IDR dispute line items for pain medicine. The median prevailing offer was 43.10x the QPA (25th–75th percentile 11.90x–90.34x; n = 11,086). The median time to a decision was 33 business days (n = 18,979).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
18,979
2025 Q1–Q4 · 20 split decisions excluded
Provider win rate
85.5%
n = 18,979 · 2025 Q1–Q4
Median days to decision
33
business days, from dispute initiation · n = 18,979 · 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 | 18,979 | 85.5% | 43.10x † | 11.90x–90.34x | 11,086 | 33 |
| 2024 Q1–Q4 | 6,417 | 79.9% | 31.15x † | 6.80x–62.00x | 3,895 | 77 |
| 2023 Q1–Q4 | 222 | 91.4% | 27.27x † | 10.84x–51.27x | 220 | 24 |
| 2023 Q1–2025 Q4 | 25,618 | 84.1% | 39.55x † | 10.71x–80.13x | 15,201 | 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 | 16,115 | 86.3% | 53.93x † | 8,316 | 35 |
| New York | 1,751 | 79.7% | 12.92x | 1,691 | 28 |
| Nevada | 541 | 84.1% | 21.12x † | 540 | 28 |
| Arizona | 437 | 80.1% | 50.11x † | 437 | 21 |
| California | 34 | 76.5% | 28.81x † | 34 | 25 |
| Pennsylvania | 34 | 76.5% | – | 17 | 33 |
| Texas | 33 | 100.0% | 56.82x † | 33 | 34 |
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 |
|---|---|---|---|---|---|
| 64484 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 1,428 | 84.1% | 63.32x † | 814 | 36 |
| 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 1,395 | 85.4% | 36.68x † | 845 | 36 |
| 36475 Destruction of first incompetent vein of arm or leg using radiofrequency and ima | 1,388 | 85.2% | 57.58x † | 529 | 30 |
| 64636 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, | 1,386 | 86.9% | 75.34x † | 691 | 36 |
| 64494 Injection of lower or sacral spine facet joint using imaging guidance, second le | 1,166 | 83.9% | 82.84x † | 696 | 36 |
| 64493 Injection of lower or sacral spine facet joint using imaging guidance, single le | 1,161 | 84.7% | 52.84x † | 687 | 36 |
| 20610 Aspiration and/or injection of fluid from large joint | 1,073 | 85.5% | 62.42x † | 480 | 33 |
| 64635 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, | 939 | 86.5% | 26.97x † | 504 | 36 |
| 64634 Destruction of upper or middle spinal facet joint nerves using imaging guidance, | 747 | 88.6% | 58.40x † | 421 | 35 |
| 64495 Injection of lower or sacral spine facet joint using imaging guidance, third and | 735 | 84.4% | 80.02x † | 390 | 36 |
| 64491 Injection of upper or middle spine facet joint using imaging guidance, second le | 728 | 87.1% | 71.28x † | 485 | 36 |
| 64490 Injection of upper or middle spine facet joint using imaging guidance, single le | 727 | 86.7% | 42.61x † | 487 | 34 |
| 36465 Injection of chemical agent into single incompetent vein of leg using ultrasound | 646 | 86.5% | 158.40x † | 248 | 30 |
| 62321 Injection of substance into middle or upper spine canal using imaging guidance | 615 | 86.5% | 35.96x † | 410 | 31 |
| 64492 Injection of upper or middle spine facet joint using imaging guidance, third and | 503 | 87.5% | 68.77x † | 325 | 36 |
| 64633 Destruction of upper or middle spinal facet joint nerves using imaging guidance, | 472 | 87.9% | 23.04x † | 274 | 34.5 |
| 01992 Anesthesia for nerve block and injection procedure, prone position | 414 | 84.8% | 17.02x | 401 | 27 |
| 00812 Anesthesia for exam of colon using an endoscope | 322 | 79.2% | 26.67x † | 318 | 23 |
| 62323 Injection of substance into lower spine canal using imaging guidance | 317 | 87.4% | 32.49x † | 249 | 33 |
| 27096 Injection of anesthetic or steroid into joint between lower spine and hip bone u | 283 | 84.1% | 32.53x † | 169 | 30 |
| 77003 Fluoroscopic guidance for spine or back muscle injection | 143 | 84.6% | 15.63x | 37 | 196 |
| 20605 Aspiration and/or injection of fluid from medium joint | 141 | 87.9% | 100.78x † | 66 | 26 |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 115 | 83.5% | 26.46x † | 113 | 23 |
| 64450 Injection of anesthetic agent and/or steroid into other nerve or branch | 89 | 85.4% | 25.16x † | 52 | 38 |
| 77002 Fluoroscopic guidance for needle placement | 77 | 81.8% | 13.29x | 47 | 165 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for pain medicine?
In 2025 Q1–Q4, the provider or facility offer was selected in 85.5% of 18,979 determined dispute line items for pain 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 pain medicine?
In 2025 Q1–Q4, the median prevailing offer was 43.10x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 11.90x to 90.34x (n = 11,086 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 pain medicine?
In 2025 Q1–Q4, the median was 33 business days (n = 18,979 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).