Federal IDR outcomes: Urology
In 2025 Q1–Q4, the provider or facility offer prevailed in 89.5% of 1,281 determined Federal IDR dispute line items for urology. The median prevailing offer was 20.83x the QPA (25th–75th percentile 9.24x–50.23x; n = 1,207). The median time to a decision was 29 business days (n = 1,281).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
1,281
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
89.5%
n = 1,281 · 2025 Q1–Q4
Median days to decision
29
business days, from dispute initiation · n = 1,281 · 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 | 1,281 | 89.5% | 20.83x † | 9.24x–50.23x | 1,207 | 29 |
| 2024 Q1–Q4 | 462 | 91.8% | 15.52x | 7.81x–24.23x | 404 | 28 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 1,759 | 90.1% | 19.15x | 8.75x–42.82x | 1,627 | 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 | 786 | 90.2% | 16.09x | 733 | 32 |
| California | 457 | 88.2% | 51.70x † | 451 | 26 |
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 |
|---|---|---|---|---|---|
| 52344 Repair of stricture of ureter using an endoscope | 178 | 89.9% | 14.49x | 161 | 33 |
| 52356 Crushing of stone of ureter with insertion of stent using an endoscope | 156 | 92.9% | 22.44x † | 154 | 29 |
| 52330 Manipulation of stone in ureter using an endoscope | 118 | 90.7% | 11.87x | 104 | 30.5 |
| 52352 Removal or manipulation of stone in ureter or kidney using an endoscope | 115 | 88.7% | 29.66x † | 99 | 37 |
| 50590 Shock wave crushing of kidney stones | 61 | 90.2% | 8.84x | 61 | 34 |
| 52332 Insertion of stent in ureter using an endoscope | 61 | 91.8% | 50.40x † | 59 | 36 |
| 55866 Surgical removal of prostate and surrounding lymph nodes using an endoscope | 42 | 85.7% | 24.23x † | 42 | 24.5 |
| 74420 Imaging of urinary tract following injection of a contrast agent | 40 | 87.5% | 177.12x † | 40 | 28 |
| 38571 Removal of lymph nodes of both sides of pelvis using an endoscope | 35 | 82.9% | 50.23x † | 35 | 25 |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 35 | 82.9% | 99.05x † | 35 | 29 |
| 52005 Insertion of tube into ureter using an endoscope through bladder area | 34 | 82.4% | 127.24x † | 32 | 36 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for urology?
In 2025 Q1–Q4, the provider or facility offer was selected in 89.5% of 1,281 determined dispute line items for urology. 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 urology?
In 2025 Q1–Q4, the median prevailing offer was 20.83x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 9.24x to 50.23x (n = 1,207 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 urology?
In 2025 Q1–Q4, the median was 29 business days (n = 1,281 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).