Federal IDR outcomes: Internal and family medicine in California
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.0% of 6,127 determined Federal IDR dispute line items for internal and family medicine in California. The median prevailing offer was 6.23x the QPA (25th–75th percentile 3.52x–10.33x; n = 6,100). The median time to a decision was 27 business days (n = 6,127).
Determined line items
6,127
2025 Q1–Q4 · 18 split decisions excluded
Provider win rate
87.0%
n = 6,127 · 2025 Q1–Q4
Median payment vs QPA
6.23x
middle half 3.52x–10.33x · n = 6,100 · 2025 Q1–Q4
Median days to decision
27
business days, from dispute initiation · n = 6,127 · 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 | 6,127 | 87.0% | 6.23x | 3.52x–10.33x | 6,100 | 27 |
| 2024 Q1–Q4 | 222 | 89.6% | 6.34x | 3.17x–10.48x | 222 | 32.5 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 6,349 | 87.1% | 6.24x | 3.51x–10.37x | 6,322 | 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 |
|---|---|---|---|---|---|
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 1,224 | 88.0% | 6.68x | 1,218 | 30 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 887 | 86.4% | 7.21x | 884 | 27 |
| 99239 Hospital discharge day management, more than 30 minutes | 775 | 88.5% | 4.73x | 769 | 27 |
| 99291 Critical care, first 30-74 minutes | 733 | 90.9% | 4.69x | 730 | 28 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 714 | 84.3% | 13.83x | 711 | 28 |
| 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscop | 193 | 90.7% | 108.86x † | 191 | 23 |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 165 | 89.1% | 95.13x † | 165 | 35 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 133 | 91.7% | 5.16x | 133 | 26 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 129 | 86.8% | 7.60x | 129 | 27 |
| 45380 Biopsy of large bowel using a flexible endoscope | 128 | 89.8% | 61.41x † | 125 | 25 |
| 99497 Advance care planning, first 30 minutes | 79 | 88.6% | 3.90x | 78 | 56 |
| 45385 Removal of polyps or growths of large bowel using an endoscope with mechanical s | 66 | 87.9% | 42.16x † | 66 | 26.5 |
| 00840 Anesthesia for other procedure on lower abdomen | 45 | 86.7% | 4.94x | 45 | 23 |
| 01967 Anesthesia for labor during planned vaginal delivery | 42 | 76.2% | 3.99x | 42 | 23 |
| 99238 Hospital discharge day management, 30 minutes or less | 38 | 78.9% | 5.82x | 38 | 29.5 |
| 45378 Diagnostic exam of large bowel using a flexible endoscope | 37 | 83.8% | 60.23x † | 37 | 23 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in California · Internal and family medicine in all states
FAQ
What is the Federal IDR provider win rate for internal and family medicine in California?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.0% of 6,127 determined dispute line items for internal and family medicine 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 internal and family medicine in California?
In 2025 Q1–Q4, the median prevailing offer was 6.23x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 3.52x to 10.33x (n = 6,100 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 internal and family medicine in California?
In 2025 Q1–Q4, the median was 27 business days (n = 6,127 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).