Federal IDR outcomes in Colorado
In 2025 Q1–Q4, the provider or facility offer prevailed in 77.1% of 27,130 determined Federal IDR dispute line items for services provided in Colorado. The median prevailing offer was 2.73x the QPA (25th–75th percentile 1.13x–10.49x; n = 25,119). The median time to a decision was 37 business days (n = 27,130).
Determined line items
27,130
2025 Q1–Q4 · 48 split decisions excluded
Provider win rate
77.1%
n = 27,130 · 2025 Q1–Q4
Median payment vs QPA
2.73x
middle half 1.13x–10.49x · n = 25,119 · 2025 Q1–Q4
Median days to decision
37
business days, from dispute initiation · n = 27,130 · 2025 Q1–Q4
Dollar amounts
Total awarded
$45.5M
sum of prevailing offers · n = 17,973 · 2025 Q1–Q4
Total QPA
$12.5M
sum of QPAs, same line items · n = 17,973 · 2025 Q1–Q4
Awarded above QPA
$33.0M
total awarded minus total QPA · n = 17,973 · 2025 Q1–Q4
Median award per line item
$1,049
mean $2,533 · n = 17,973 · 2025 Q1–Q4
Median QPA
$243
per line item · n = 17,973 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.65x
total awarded ÷ total QPA · n = 17,973 · 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 | 17,973 | $45.5M | $12.5M | $33.0M | $1,049 | $243 | 3.65x |
| 2024 Q3–Q4 | 2,961 | $8.1M | $1.7M | $6.4M | $1,122 | $202 | 4.83x |
| 2024 Q3–2025 Q4 | 20,934 | $53.6M | $14.1M | $39.5M | $1,066 | $238 | 3.79x |
| 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 | 27,130 | 77.1% | 2.73x | 1.13x–10.49x | 25,119 | 37 |
| 2024 Q1–Q4 | 5,916 | 81.1% | 4.71x | 1.33x–11.64x | 5,515 | 62 |
| 2023 Q1–Q4 | 505 | 70.7% | 4.70x | 1.10x–7.11x | 431 | 78 |
| 2023 Q1–2025 Q4 | 33,551 | 77.7% | 3.03x | 1.20x–10.53x | 31,065 | 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 Colorado
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Intraoperative neuromonitoring | 9,285 | 85.2% | 18.74x | 7,877 | 35 |
| Hospitals and facilities | 4,745 | 43.5% | 1.00x | 4,698 | 93 |
| Emergency medicine and emergency departments | 4,574 | 88.0% | 2.32x | 4,556 | 30 |
| General and other surgery | 3,890 | 86.7% | 5.22x | 3,811 | 49 |
| Anesthesiology | 3,009 | 78.6% | 2.56x | 3,006 | 24 |
| Not reported / unspecified | 622 | 46.1% | 1.00x | 186 | 34 |
| Laboratory and pathology | 436 | 97.9% | 1.00x | 431 | 64 |
| Neurology | 277 | 85.2% | 32.98x † | 277 | 32 |
| Plastic and reconstructive surgery | 98 | 90.8% | 10.63x | 95 | 25 |
| Other / unclassified labels | 79 | 74.7% | 1.00x | 70 | 29 |
| Orthopedic surgery | 55 | 83.6% | 23.19x † | 52 | 23 |
| Internal and family medicine | 34 | 70.6% | 5.72x | 34 | 27.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Colorado
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 2,628 | 85.0% | 2.26x | 2,617 | 32 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 2,391 | 84.4% | 39.18x † | 2,065 | 35 |
| 99285 Emergency department visit with high level of medical decision making | 1,854 | 80.9% | 2.10x | 1,844 | 33 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 1,342 | 86.1% | 13.54x | 1,111 | 35 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 1,184 | 85.1% | 18.55x | 1,019 | 33 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 1,030 | 86.1% | 13.20x | 841 | 36.5 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 963 | 85.2% | 5.00x | 958 | 63 |
| 95937 Testing of nerve-muscle junction | 721 | 83.8% | 28.69x † | 580 | 33 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 705 | 84.8% | 22.14x † | 621 | 35 |
| 99283 Emergency department visit with low level of medical decision making | 662 | 90.0% | 2.78x | 657 | 30 |
| 99291 Critical care, first 30-74 minutes | 559 | 82.1% | 6.55x | 554 | 44 |
| 00812 Anesthesia for exam of colon using an endoscope | 552 | 84.2% | 2.17x | 552 | 27 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 426 | 85.4% | 4.72x | 418 | 48.5 |
| 95870 Needle measurement of electrical activity in arm, leg, trunk or head muscles, li | 413 | 86.0% | 20.30x † | 323 | 39 |
| 95940 Continuous monitoring of nervous system during operation, each 15 minutes | 324 | 85.8% | 18.30x | 253 | 37 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 300 | 45.0% | 1.00x | 270 | 81 |
| 44970 Removal of appendix using an endoscope | 292 | 84.9% | 4.64x | 290 | 45 |
| 81420 Test for detecting genes associated with fetal disease, aneuploidy genomic seque | 286 | 99.0% | 1.00x | 286 | 55 |
| 80053 Blood test, comprehensive group of blood chemicals | 264 | 46.2% | 1.00x | 237 | 83.5 |
| 01967 Anesthesia for labor during planned vaginal delivery | 258 | 71.3% | 2.53x | 258 | 24 |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 222 | 79.3% | 2.55x | 222 | 26 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 211 | 86.3% | 5.38x | 210 | 49 |
| 47562 Removal of gallbladder using an endoscope | 187 | 81.3% | 4.40x | 186 | 46 |
| 00840 Anesthesia for other procedure on lower abdomen | 182 | 78.0% | 2.60x | 182 | 24 |
| 96374 Injection of drug or substance into vein | 177 | 46.9% | 1.00x | 161 | 80 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Colorado
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 |
|---|---|---|---|---|---|
| CIGNA (multiplan.com) | 8,892 | 61.3% | 1.20x | 8,630 | 52 |
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 6,916 | 88.2% | 7.26x | 6,094 | 36.5 |
| UNITED HEALTHCARE (uhc.com) | 4,659 | 79.6% | 5.05x | 4,339 | 38 |
| AETNA (aetna.com) | 1,949 | 91.0% | 4.46x | 1,705 | 29 |
| UMR (clearhs.com) | 1,500 | 83.5% | 4.71x | 1,436 | 30 |
| UMR (clearhealthcloud.com) | 1,022 | 92.7% | 2.13x | 1,006 | 39 |
| BCBSTX (bcbstx.com) | 576 | 92.7% | 21.00x † | 545 | 30 |
| CIGNA (cigna.com) | 343 | 85.1% | 6.57x | 307 | 34 |
| RES-CARE, INC. DBA BRIGHTSPRING HEALTH SERVICES (springtidehealth.com) | 228 | 34.6% | 0.29x | 165 | 36 |
| FORT WORTH FIREFIGHTERS HEALTHCARE TRUST MEDICAL BASIC & CONSUMER CHOICE PLANS (6degreeshealth.com) | 123 | 53.7% | 1.00x | 114 | 22 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Colorado
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 2,518 | $3.3M | $593 | $265 | 2.02x |
| 99285 Emergency department visit with high level of medical decision making | 1,772 | $6.4M | $1,035 | $395 | 1.53x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 1,591 | $6.4M | $3,500 | $79 | 22.37x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 879 | $493,916 | $531 | $107 | 5.26x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 803 | $2.1M | $1,760 | $140 | 15.01x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 793 | $3.7M | $4,458 | $206 | 14.46x |
| 99283 Emergency department visit with low level of medical decision making | 604 | $540,956 | $388 | $142 | 2.59x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 539 | $3.7M | $3,600 | $293 | 10.76x |
| 00812 Anesthesia for exam of colon using an endoscope | 529 | $639,726 | $1,260 | $609 | 2.04x |
| 99291 Critical care, first 30-74 minutes | 468 | $1.4M | $2,688 | $341 | 2.15x |
| 95937 Testing of nerve-muscle junction | 405 | $2.0M | $1,600 | $105 | 20.51x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 382 | $260,836 | $724 | $154 | 4.50x |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 372 | $1.2M | $2,000 | $82 | 19.14x |
| 44970 Removal of appendix using an endoscope | 246 | $967,979 | $4,633 | $936 | 4.19x |
| 01967 Anesthesia for labor during planned vaginal delivery | 235 | $716,574 | $2,783 | $1,257 | 2.26x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 231 | $36,562 | $193 | $193 | 0.76x |
| 95870 Needle measurement of electrical activity in arm, leg, trunk or head muscles, li | 226 | $607,373 | $1,482 | $64 | 16.54x |
| 80053 Blood test, comprehensive group of blood chemicals | 202 | $31,360 | $185 | $185 | 0.78x |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 199 | $236,413 | $1,242 | $486 | 2.21x |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 174 | $181,029 | $1,122 | $205 | 5.00x |
| 95940 Continuous monitoring of nervous system during operation, each 15 minutes | 162 | $2.0M | $6,400 | $396 | 18.68x |
| 00840 Anesthesia for other procedure on lower abdomen | 161 | $274,226 | $1,508 | $608 | 2.52x |
| 47562 Removal of gallbladder using an endoscope | 141 | $538,168 | $4,655 | $1,043 | 4.09x |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 140 | $72,825 | $629 | $629 | 0.75x |
| 96361 Infusion into a vein for hydration, each additional hour | 132 | $94,164 | $475 | $950 | 0.77x |
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 Colorado?
In 2025 Q1–Q4, the provider or facility offer was selected in 77.1% of 27,130 determined dispute line items for services provided in Colorado. 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 Colorado?
In 2025 Q1–Q4, the median prevailing offer was 2.73x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.13x to 10.49x (n = 25,119 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 Colorado?
In 2025 Q1–Q4, the median was 37 business days (n = 27,130 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Colorado figures count line items whose place of service was Colorado. See methodology for caveats.