Federal IDR outcomes: Urology in California
In 2025 Q1–Q4, the provider or facility offer prevailed in 88.2% of 457 determined Federal IDR dispute line items for urology in California. The median prevailing offer was 51.70x the QPA (25th–75th percentile 20.18x–116.40x; n = 451). The median time to a decision was 26 business days (n = 457).
Determined line items
457
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
88.2%
n = 457 · 2025 Q1–Q4
Median days to decision
26
business days, from dispute initiation · n = 457 · 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 | 457 | 88.2% | 51.70x † | 20.18x–116.40x | 451 | 26 |
| 2024 Q1–Q4 | 50 | 84.0% | 21.48x † | 3.24x–31.31x | 50 | 42 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 508 | 87.8% | 45.48x † | 16.28x–112.02x | 502 | 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 |
|---|---|---|---|---|---|
| 55866 Surgical removal of prostate and surrounding lymph nodes using an endoscope | 40 | 87.5% | 24.23x † | 40 | 24 |
| 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 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in California · Urology in all states
FAQ
What is the Federal IDR provider win rate for urology in California?
In 2025 Q1–Q4, the provider or facility offer was selected in 88.2% of 457 determined dispute line items for urology 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 Withdrawn, settled and ineligible disputes are not in the CMS data.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 urology in California?
In 2025 Q1–Q4, the median prevailing offer was 51.70x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 20.18x to 116.40x (n = 451 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 California?
In 2025 Q1–Q4, the median was 26 business days (n = 457 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).