Federal IDR outcomes: Laboratory and pathology in California
In 2025 Q1–Q4, the provider or facility offer prevailed in 75.9% of 456 determined Federal IDR dispute line items for laboratory and pathology in California. The median prevailing offer was 6.14x the QPA (25th–75th percentile 1.00x–97.41x; n = 454). The median time to a decision was 25 business days (n = 456).
Determined line items
456
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
75.9%
n = 456 · 2025 Q1–Q4
Median payment vs QPA
6.14x
middle half 1.00x–97.41x · n = 454 · 2025 Q1–Q4
Median days to decision
25
business days, from dispute initiation · n = 456 · 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 | 456 | 75.9% | 6.14x | 1.00x–97.41x | 454 | 25 |
| 2024 Q1–Q4 | 44 | 86.4% | 0.71x | 0.69x–1.10x | 44 | 240 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 501 | 76.8% | 3.28x | 1.00x–77.54x | 499 | 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 |
|---|---|---|---|---|---|
| 88305 Pathology examination of tissue using a microscope, intermediate complexity | 100 | 78.0% | 34.66x † | 100 | 23.5 |
| 0326U Targeted genomic sequence analysis of 83 or more genes in cell free circulating | 87 | 78.2% | 1.00x | 86 | 30 |
| 88313 Special stained specimen slides to examine tissue including interpretation and r | 87 | 79.3% | 168.67x † | 87 | 23 |
| 88342 Special stained specimen slides to examine tissue, initial procedure | 52 | 67.3% | 18.64x | 51 | 23.5 |
| 0242U Gene analysis of 55-74 genes associated with solid organ cancer in cell-free cir | 50 | 70.0% | 1.00x | 50 | 30 |
| 88312 Special stained specimen slides to identify organisms including interpretation a | 32 | 78.1% | 138.10x † | 32 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in California · Laboratory and pathology in all states
FAQ
What is the Federal IDR provider win rate for laboratory and pathology in California?
In 2025 Q1–Q4, the provider or facility offer was selected in 75.9% of 456 determined dispute line items for laboratory and pathology 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 laboratory and pathology in California?
In 2025 Q1–Q4, the median prevailing offer was 6.14x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.00x to 97.41x (n = 454 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 laboratory and pathology in California?
In 2025 Q1–Q4, the median was 25 business days (n = 456 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).