Federal IDR outcomes in Connecticut
In 2025 Q1–Q4, the provider or facility offer prevailed in 82.1% of 14,258 determined Federal IDR dispute line items for services provided in Connecticut. The median prevailing offer was 3.24x the QPA (25th–75th percentile 1.81x–10.24x; n = 11,573). The median time to a decision was 36 business days (n = 14,258).
Determined line items
14,258
2025 Q1–Q4 · 8 split decisions excluded
Provider win rate
82.1%
n = 14,258 · 2025 Q1–Q4
Median payment vs QPA
3.24x
middle half 1.81x–10.24x · n = 11,573 · 2025 Q1–Q4
Median days to decision
36
business days, from dispute initiation · n = 14,258 · 2025 Q1–Q4
Dollar amounts
Total awarded
$54.2M
sum of prevailing offers · n = 8,383 · 2025 Q1–Q4
Total QPA
$4.2M
sum of QPAs, same line items · n = 8,383 · 2025 Q1–Q4
Awarded above QPA
$50.0M
total awarded minus total QPA · n = 8,383 · 2025 Q1–Q4
Median award per line item
$740
mean $6,470 · n = 8,383 · 2025 Q1–Q4
Median QPA
$239
per line item · n = 8,383 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
12.87x
total awarded ÷ total QPA · n = 8,383 · 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 | 8,383 | $54.2M | $4.2M | $50.0M | $740 | $239 | 12.87x |
| 2024 Q3–Q4 | 1,376 | $8.4M | $834,532 | $7.6M | $740 | $211 | 10.07x |
| 2024 Q3–2025 Q4 | 9,759 | $62.6M | $5.0M | $57.6M | $740 | $236 | 12.41x |
| 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 | 14,258 | 82.1% | 3.24x | 1.81x–10.24x | 11,573 | 36 |
| 2024 Q1–Q4 | 3,997 | 78.2% | 3.72x | 1.57x–23.70x | 3,240 | 83 |
| 2023 Q1–Q4 | 345 | 61.2% | 1.91x | 1.00x–3.90x | 310 | 61 |
| 2023 Q1–2025 Q4 | 18,600 | 80.8% | 3.32x | 1.79x–14.64x | 15,123 | 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 Connecticut
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 6,990 | 79.7% | 2.95x | 6,636 | 36 |
| Plastic and reconstructive surgery | 3,199 | 92.7% | 30.74x † | 1,623 | 32 |
| Intraoperative neuromonitoring | 2,805 | 82.8% | 18.70x | 2,128 | 37 |
| Not reported / unspecified | 344 | 4.9% | 1.25x | 312 | 228 |
| Hospitals and facilities | 212 | 100.0% | 3.63x | 202 | 49 |
| Neurology | 160 | 86.2% | 25.97x † | 155 | 50.5 |
| Infectious disease | 132 | 82.6% | 2.41x | 131 | 40 |
| Hospital medicine (hospitalists) | 127 | 90.6% | 1.68x | 127 | 27 |
| Anesthesiology | 76 | 89.5% | 2.23x | 76 | 37 |
| Neurosurgery and spine surgery | 59 | 93.2% | 27.21x † | 53 | 129 |
| General and other surgery | 40 | 95.0% | 5.43x | 34 | 33 |
| Other / unclassified labels | 32 | 78.1% | 4.19x | 31 | 31 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Connecticut
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99285 Emergency department visit with high level of medical decision making | 3,453 | 72.7% | 2.75x | 3,368 | 36 |
| 99284 Emergency department visit with moderate level of medical decision making | 2,738 | 78.8% | 3.00x | 2,695 | 39 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 775 | 83.2% | 31.97x † | 610 | 37 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 509 | 82.3% | 18.25x | 421 | 37 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 393 | 86.0% | 15.25x | 283 | 39 |
| 99283 Emergency department visit with low level of medical decision making | 354 | 91.2% | 2.55x | 344 | 27 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 350 | 85.1% | 10.32x | 255 | 34.5 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 329 | 92.4% | 2.41x | 322 | 43 |
| 19318 Breast reduction | 300 | 90.7% | 26.85x † | 218 | 30.5 |
| 99291 Critical care, first 30-74 minutes | 250 | 92.0% | 3.27x | 243 | 31 |
| 19380 Surgical change to reconstructed breast | 200 | 94.5% | 73.60x † | 97 | 30.5 |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 192 | 90.6% | 46.44x † | 108 | 32 |
| 95937 Testing of nerve-muscle junction | 189 | 82.5% | 29.83x † | 120 | 33 |
| 99053 Service provided between 10:00 pm and 8:00 am at a 24-hour facility | 183 | 73.8% | – | 10 | 38 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 162 | 85.2% | 44.40x † | 145 | 39 |
| 19357 Reconstruction of breast using tissue expander | 158 | 91.8% | 81.06x † | 84 | 33 |
| 15777 Implantation of biologic implant to soft tissue | 143 | 93.7% | 101.81x † | 63 | 33 |
| 15771 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 134 | 94.0% | 15.98x | 52 | 30 |
| 95870 Needle measurement of electrical activity in arm, leg, trunk or head muscles, li | 134 | 82.8% | 32.96x † | 83 | 38 |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 131 | 86.3% | 40.48x † | 64 | 35 |
| 38530 Biopsy or removal of lymph nodes of breast | 116 | 91.4% | 81.93x † | 60 | 29 |
| 19350 Reconstruction of nipple or area around nipple | 108 | 86.1% | 37.59x † | 69 | 31 |
| 32900 Removal of ribs | 90 | 95.6% | 34.48x † | 42 | 30.5 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 84 | 98.8% | 1.82x | 83 | 29 |
| 15002 Preparation of skin graft site of trunk, arms, or legs, 100.0 sq cm or 1% body a | 82 | 97.6% | 38.50x † | 41 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Connecticut
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 (cigna.com) | 4,000 | 68.2% | 2.75x | 3,452 | 46 |
| AETNA (aetna.com) | 3,101 | 94.6% | 3.18x | 2,789 | 29 |
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 2,809 | 85.8% | 19.62x | 1,999 | 36 |
| UNITED HEALTHCARE (uhc.com) | 1,722 | 75.3% | 4.16x | 1,357 | 39 |
| EMBLEM HEALTH (emblemhealth.com) | 703 | 91.7% | 7.66x | 524 | 28 |
| UMR (clearhealthcloud.com) | 489 | 86.1% | 1.77x | 473 | 29 |
| CIGNA (multiplan.com) | 311 | 89.4% | 30.49x † | 156 | 31 |
| UMR (clearhs.com) | 232 | 87.9% | 5.36x | 192 | 26 |
| BCBS OF TX (bcbsil.com) | 169 | 100.0% | 2.99x | 167 | 375 |
| FLORIDA BLUE (bcbsfl.com) | 135 | 91.9% | 18.51x | 108 | 20 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Connecticut
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99285 Emergency department visit with high level of medical decision making | 3,044 | $2.2M | $740 | $250 | 2.45x |
| 99284 Emergency department visit with moderate level of medical decision making | 2,499 | $1.4M | $566 | $187 | 2.46x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 426 | $1.9M | $2,560 | $78 | 10.74x |
| 99283 Emergency department visit with low level of medical decision making | 373 | $152,549 | $391 | $151 | 2.75x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 290 | $1.7M | $4,264 | $200 | 17.02x |
| 19318 Breast reduction | 189 | $13.5M | $60,000 | $1,828 | 31.47x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 175 | $603,929 | $2,600 | $151 | 15.55x |
| 99291 Critical care, first 30-74 minutes | 132 | $147,895 | $1,180 | $306 | 3.67x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 116 | $921,765 | $4,300 | $597 | 4.80x |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 90 | $3.5M | $42,625 | $674 | 18.59x |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 89 | $395,453 | $4,654 | $94 | 32.02x |
| 19380 Surgical change to reconstructed breast | 76 | $5.1M | $70,000 | $862 | 64.29x |
| 19350 Reconstruction of nipple or area around nipple | 53 | $1.6M | $25,000 | $624 | 40.52x |
| 19357 Reconstruction of breast using tissue expander | 53 | $5.0M | $88,000 | $1,582 | 39.69x |
| 95937 Testing of nerve-muscle junction | 53 | $273,602 | $1,275 | $153 | 30.32x |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 48 | $1,635 | $8 | $8 | 3.84x |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 46 | $1.9M | $32,000 | $606 | 9.54x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 43 | $10,277 | $239 | $141 | 1.73x |
| 95870 Needle measurement of electrical activity in arm, leg, trunk or head muscles, li | 42 | $111,168 | $2,425 | $77 | 35.05x |
| 15777 Implantation of biologic implant to soft tissue | 38 | $1.9M | $52,000 | $354 | 48.67x |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 37 | $14,366 | $351 | $274 | 1.49x |
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 Connecticut?
In 2025 Q1–Q4, the provider or facility offer was selected in 82.1% of 14,258 determined dispute line items for services provided in Connecticut. 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 Connecticut?
In 2025 Q1–Q4, the median prevailing offer was 3.24x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.81x to 10.24x (n = 11,573 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 Connecticut?
In 2025 Q1–Q4, the median was 36 business days (n = 14,258 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Connecticut figures count line items whose place of service was Connecticut. See methodology for caveats.