Federal IDR outcomes: Emergency medicine and emergency departments in California
In 2025 Q1–Q4, the provider or facility offer prevailed in 89.9% of 57,846 determined Federal IDR dispute line items for emergency medicine and emergency departments in California. The median prevailing offer was 2.64x the QPA (25th–75th percentile 2.00x–3.86x; n = 52,857). The median time to a decision was 30 business days (n = 57,846).
Determined line items
57,846
2025 Q1–Q4 · 26 split decisions excluded
Provider win rate
89.9%
n = 57,846 · 2025 Q1–Q4
Median payment vs QPA
2.64x
middle half 2.00x–3.86x · n = 52,857 · 2025 Q1–Q4
Median days to decision
30
business days, from dispute initiation · n = 57,846 · 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 | 57,846 | 89.9% | 2.64x | 2.00x–3.86x | 52,857 | 30 |
| 2024 Q1–Q4 | 11,158 | 80.7% | 2.26x | 1.40x–2.98x | 6,972 | 131 |
| 2023 Q1–Q4 | 649 | 80.0% | 1.76x | 1.20x–2.58x | 412 | 36 |
| 2023 Q1–2025 Q4 | 69,653 | 88.3% | 2.58x | 1.95x–3.80x | 60,241 | 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.
Most disputed CPT codes
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 24,491 | 91.1% | 2.59x | 23,032 | 30 |
| 99285 Emergency department visit with high level of medical decision making | 21,029 | 90.7% | 2.54x | 19,821 | 30 |
| 99283 Emergency department visit with low level of medical decision making | 3,673 | 91.2% | 2.79x | 3,444 | 30 |
| 99291 Critical care, first 30-74 minutes | 2,437 | 87.6% | 2.56x | 2,335 | 29 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 1,164 | 86.3% | 6.45x | 755 | 24 |
| 99053 Service provided between 10:00 pm and 8:00 am at a 24-hour facility | 344 | 82.0% | 3.81x | 199 | 24 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 176 | 77.3% | 4.08x | 89 | 44.5 |
| 80053 Blood test, comprehensive group of blood chemicals | 174 | 75.9% | 5.34x | 90 | 45 |
| 99282 Emergency department visit with straightforward medical decision making | 156 | 83.3% | 4.32x | 153 | 22 |
| 12001 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, | 146 | 91.8% | 5.03x | 145 | 24.5 |
| 36415 Insertion of needle into vein for collection of blood sample | 136 | 75.7% | 4.03x | 67 | 43.5 |
| 71045 X-ray of chest, 1 view | 127 | 88.2% | 4.19x | 99 | 28 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 122 | 86.1% | 5.03x | 120 | 50.5 |
| 12011 Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 | 111 | 87.4% | 4.52x | 107 | 23 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 111 | 73.0% | 21.74x † | 111 | 32 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 106 | 93.4% | 5.45x | 99 | 27 |
| 12002 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, | 96 | 89.6% | 4.94x | 87 | 24 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 95 | 81.1% | 3.66x | 50 | 45 |
| 83690 Lipase (fat enzyme) level | 76 | 77.6% | 4.34x | 40 | 39.5 |
| 84484 Troponin (protein) analysis, quantitative | 70 | 82.9% | 3.78x | 35 | 45 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in California · Emergency medicine and emergency departments in all states
FAQ
What is the Federal IDR provider win rate for emergency medicine and emergency departments in California?
In 2025 Q1–Q4, the provider or facility offer was selected in 89.9% of 57,846 determined dispute line items for emergency medicine and emergency departments in California. 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 emergency medicine and emergency departments in California?
In 2025 Q1–Q4, the median prevailing offer was 2.64x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.00x to 3.86x (n = 52,857 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 emergency medicine and emergency departments in California?
In 2025 Q1–Q4, the median was 30 business days (n = 57,846 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).