Federal IDR outcomes in Arizona
In 2025 Q1–Q4, the provider or facility offer prevailed in 83.3% of 439,946 determined Federal IDR dispute line items for services provided in Arizona. The median prevailing offer was 4.80x the QPA (25th–75th percentile 2.55x–8.90x; n = 330,224). The median time to a decision was 38 business days (n = 439,946).
Determined line items
439,946
2025 Q1–Q4 · 364 split decisions excluded
Provider win rate
83.3%
n = 439,946 · 2025 Q1–Q4
Median payment vs QPA
4.80x
middle half 2.55x–8.90x · n = 330,224 · 2025 Q1–Q4
Median days to decision
38
business days, from dispute initiation · n = 439,946 · 2025 Q1–Q4
Dollar amounts
Total awarded
$706.5M
sum of prevailing offers · n = 309,051 · 2025 Q1–Q4
Total QPA
$91.9M
sum of QPAs, same line items · n = 309,051 · 2025 Q1–Q4
Awarded above QPA
$614.6M
total awarded minus total QPA · n = 309,051 · 2025 Q1–Q4
Median award per line item
$569
mean $2,286 · n = 309,051 · 2025 Q1–Q4
Median QPA
$142
per line item · n = 309,051 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
7.69x
total awarded ÷ total QPA · n = 309,051 · 2025 Q1–Q4
Dollar amounts come from the separate CMS “QPA and Offers” file: line items decided for the provider or the plan with a non-suppressed QPA and prevailing offer. That file cannot be joined to the line items above, so its n differs. Awarded = the prevailing (selected) offer; it is not a record of what was paid. State comes from the file’s geographic region; a metro area that spans states counts in each. How the dollar figures work
Dollar amounts by period
| Period | Line items with $ | Total awarded | Total QPA | Above QPA | Median award | Median QPA | Award ×QPA ($-weighted) |
|---|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | 309,051 | $706.5M | $91.9M | $614.6M | $569 | $142 | 7.69x |
| 2024 Q3–Q4 | 97,409 | $118.8M | $21.1M | $97.6M | $354 | $118 | 5.62x |
| 2024 Q3–2025 Q4 | 406,460 | $825.2M | $113.0M | $712.2M | $504 | $134 | 7.30x |
| 2023 Q1–2024 Q2 | Not available (see methodology). | ||||||
From the CMS QPA and Offers file (see above). Award ×QPA here is total awarded ÷ total QPA, so large claims weigh more than in the per-line median ratio.
By period
| Period | Line items | Win % | Median ×QPA | 25th–75th | Ratio n | Median days |
|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | 439,946 | 83.3% | 4.80x | 2.55x–8.90x | 330,224 | 38 |
| 2024 Q1–Q4 | 187,694 | 81.1% | 3.58x | 2.12x–6.98x | 148,398 | 71 |
| 2023 Q1–Q4 | 28,447 | 71.3% | 2.32x | 1.28x–4.40x | 25,587 | 72 |
| 2023 Q1–2025 Q4 | 656,087 | 82.2% | 4.14x | 2.19x–8.10x | 504,209 | 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 specialty in Arizona
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 177,255 | 82.7% | 3.42x | 132,797 | 41 |
| Radiology | 119,766 | 92.6% | 5.54x | 119,603 | 59 |
| Anesthesiology | 57,846 | 80.8% | 14.47x | 52,493 | 29 |
| Hospitals and facilities | 47,943 | 76.7% | 3.00x | 4,382 | 24 |
| Not reported / unspecified | 21,077 | 59.0% | 1.29x | 5,822 | 29 |
| Intraoperative neuromonitoring | 7,777 | 84.4% | 24.89x † | 6,938 | 28 |
| Hospital medicine (hospitalists) | 2,737 | 75.9% | 1.87x | 2,737 | 20 |
| Internal and family medicine | 1,309 | 77.6% | 8.27x | 1,307 | 34 |
| Surgical assistant services | 1,136 | 82.0% | 35.48x † | 1,115 | 28 |
| Plastic and reconstructive surgery | 509 | 91.0% | 16.72x | 480 | 25 |
| Pain medicine | 437 | 80.1% | 50.11x † | 437 | 21 |
| General and other surgery | 429 | 84.8% | 25.86x † | 425 | 28 |
| Neurosurgery and spine surgery | 403 | 89.6% | 126.12x † | 390 | 22 |
| Neurology | 377 | 82.0% | 44.63x † | 374 | 29 |
| Orthopedic surgery | 354 | 90.1% | 208.63x † | 353 | 28 |
| Other / unclassified labels | 350 | 74.3% | 0.80x | 334 | 27 |
| Vascular surgery | 95 | 95.8% | 57.06x † | 94 | 28 |
| Obstetrics and gynecology | 58 | 63.8% | 32.02x † | 55 | 22.5 |
| Neonatology | 54 | 96.3% | 2.93x | 54 | 166 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Arizona
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 68,782 | 78.6% | 2.74x | 50,509 | 43 |
| 99285 Emergency department visit with high level of medical decision making | 51,710 | 80.5% | 2.96x | 32,190 | 44 |
| 71045 X-ray of chest, 1 view | 21,879 | 91.5% | 6.43x | 20,728 | 74 |
| 99283 Emergency department visit with low level of medical decision making | 15,607 | 82.1% | 4.12x | 10,934 | 30 |
| 74177 CT scan of abdomen and pelvis with contrast | 15,159 | 89.9% | 5.37x | 14,311 | 48 |
| 00812 Anesthesia for exam of colon using an endoscope | 10,732 | 76.9% | 17.15x | 10,372 | 30 |
| 70450 CT scan head or brain without contrast | 10,730 | 90.9% | 4.59x | 9,987 | 61 |
| 80053 Blood test, comprehensive group of blood chemicals | 7,037 | 79.6% | 12.61x | 3,237 | 28 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 6,745 | 79.9% | 9.32x | 2,713 | 28 |
| 99291 Critical care, first 30-74 minutes | 6,352 | 87.1% | 3.71x | 4,078 | 37 |
| 71046 X-ray of chest, 2 views | 6,348 | 90.6% | 6.49x | 5,874 | 56 |
| 74176 CT scan of abdomen and pelvis without contrast | 6,076 | 89.0% | 5.44x | 5,444 | 51 |
| 71275 CT scan of blood vessels of chest with contrast | 5,280 | 90.8% | 5.41x | 4,987 | 61 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 5,197 | 87.6% | 4.51x | 2,458 | 43 |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 4,868 | 80.5% | 16.74x | 4,518 | 30 |
| 00813 Anesthesia for procedure on small and large bowel using an endoscope | 4,222 | 78.0% | 15.80x | 4,032 | 30 |
| 00811 Anesthesia for other procedure on large bowel using an endoscope | 3,674 | 73.7% | 15.64x | 3,487 | 32 |
| 81003 Automated urinalysis test | 3,561 | 79.3% | 15.20x | 1,868 | 28 |
| 76705 Limited ultrasound scan of abdomen | 3,375 | 90.8% | 7.22x | 3,156 | 39 |
| 96375 Injection of additional new drug or substance into vein | 3,178 | 80.0% | 3.63x | 725 | 25 |
| 72125 CT scan of upper spine without contrast | 3,122 | 91.4% | 4.69x | 2,906 | 42 |
| 83690 Lipase (fat enzyme) level | 3,106 | 79.8% | 9.68x | 1,431 | 27 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 3,019 | 80.8% | 6.85x | 1,298 | 29 |
| 96374 Injection of drug or substance into vein | 2,910 | 78.0% | 2.57x | 1,182 | 27 |
| 01992 Anesthesia for nerve block and injection procedure, prone position | 2,858 | 82.8% | 29.35x † | 2,827 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Arizona
Payer = health plan/issuer email domain reported by CMS, with the most common plan name for that domain. Some domains belong to vendors acting for plans.
| Payer (email domain) | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF ARIZONA (azblue.com) | 146,359 | 78.0% | 5.61x | 90,033 | 31 |
| UNITED HEALTHCARE (uhc.com) | 144,599 | 84.9% | 6.36x | 115,479 | 53 |
| CIGNA (cigna.com) | 50,945 | 85.7% | 2.85x | 47,581 | 47 |
| AETNA (aetna.com) | 45,485 | 87.3% | 3.33x | 36,664 | 32 |
| UMR (clearhs.com) | 28,349 | 88.5% | 4.65x | 21,571 | 33 |
| CIGNA (zelis.com) | 4,838 | 96.5% | 2.82x | 4,255 | 44 |
| UMR (clearhealthcloud.com) | 3,752 | 80.9% | 3.74x | 2,301 | 47 |
| CIGNA (multiplan.com) | 3,395 | 80.5% | 3.76x | 2,317 | 39 |
| AMBETTER (centene.com) | 3,326 | 96.6% | 8.94x | 2,835 | 25 |
| BCBSTX (bcbstx.com) | 1,119 | 88.7% | 10.06x | 1,009 | 49 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Arizona
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 48,504 | $50.2M | $615 | $193 | 3.19x |
| 99285 Emergency department visit with high level of medical decision making | 31,164 | $62.0M | $821 | $252 | 4.69x |
| 71045 X-ray of chest, 1 view | 18,323 | $1.7M | $99 | $12 | 5.97x |
| 74177 CT scan of abdomen and pelvis with contrast | 12,917 | $18.1M | $956 | $134 | 5.62x |
| 99283 Emergency department visit with low level of medical decision making | 10,505 | $14.8M | $1,260 | $165 | 3.89x |
| 00812 Anesthesia for exam of colon using an endoscope | 10,150 | $67.5M | $5,970 | $327 | 19.46x |
| 70450 CT scan head or brain without contrast | 9,021 | $5.8M | $360 | $59 | 6.45x |
| 71046 X-ray of chest, 2 views | 5,346 | $1.2M | $116 | $15 | 5.69x |
| 74176 CT scan of abdomen and pelvis without contrast | 4,872 | $5.1M | $914 | $128 | 5.05x |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 4,390 | $30.4M | $6,965 | $345 | 18.16x |
| 71275 CT scan of blood vessels of chest with contrast | 4,388 | $4.7M | $941 | $135 | 5.48x |
| 99291 Critical care, first 30-74 minutes | 3,990 | $6.1M | $980 | $269 | 4.11x |
| 00813 Anesthesia for procedure on small and large bowel using an endoscope | 3,889 | $32.6M | $7,960 | $405 | 19.36x |
| 80053 Blood test, comprehensive group of blood chemicals | 3,519 | $2.4M | $824 | $35 | 7.07x |
| 00811 Anesthesia for other procedure on large bowel using an endoscope | 3,377 | $22.4M | $5,970 | $314 | 19.22x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 3,273 | $958,126 | $309 | $26 | 6.46x |
| 76705 Limited ultrasound scan of abdomen | 2,823 | $976,304 | $273 | $38 | 6.35x |
| 01992 Anesthesia for nerve block and injection procedure, prone position | 2,700 | $22.2M | $6,965 | $210 | 26.41x |
| 72125 CT scan of upper spine without contrast | 2,634 | $1.6M | $447 | $78 | 4.96x |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 2,505 | $269,412 | $48 | $13 | 6.19x |
| 70498 CT scan of blood vessels of neck with contrast | 2,250 | $2.1M | $878 | $123 | 5.79x |
| 81003 Automated urinalysis test | 2,178 | $360,701 | $194 | $8 | 7.62x |
| 70496 CT scan of blood vessels of head with contrast | 2,103 | $1.7M | $730 | $117 | 4.74x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 1,972 | $9.4M | $2,862 | $57 | 24.91x |
| 93971 Ultrasound study of one arm or leg veins with compression and maneuvers | 1,924 | $614,561 | $271 | $27 | 5.42x |
2025 Q1–Q4 · CMS QPA and Offers file · rows with n ≥ 30 line items with dollar amounts · sorted by n · Award ×QPA = total awarded ÷ total QPA.
FAQ
What is the Federal IDR provider win rate for services provided in Arizona?
In 2025 Q1–Q4, the provider or facility offer was selected in 83.3% of 439,946 determined dispute line items for services provided in Arizona. 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 services provided in Arizona?
In 2025 Q1–Q4, the median prevailing offer was 4.80x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.55x to 8.90x (n = 330,224 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 services provided in Arizona?
In 2025 Q1–Q4, the median was 38 business days (n = 439,946 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Arizona figures count line items whose place of service was Arizona. See methodology for caveats.