Federal IDR outcomes in Indiana
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.3% of 135,766 determined Federal IDR dispute line items for services provided in Indiana. The median prevailing offer was 3.59x the QPA (25th–75th percentile 2.46x–6.12x; n = 133,834). The median time to a decision was 34 business days (n = 135,766).
Determined line items
135,766
2025 Q1–Q4 · 188 split decisions excluded
Provider win rate
87.3%
n = 135,766 · 2025 Q1–Q4
Median payment vs QPA
3.59x
middle half 2.46x–6.12x · n = 133,834 · 2025 Q1–Q4
Median days to decision
34
business days, from dispute initiation · n = 135,766 · 2025 Q1–Q4
Dollar amounts
Total awarded
$175.8M
sum of prevailing offers · n = 149,010 · 2025 Q1–Q4
Total QPA
$49.4M
sum of QPAs, same line items · n = 149,010 · 2025 Q1–Q4
Awarded above QPA
$126.4M
total awarded minus total QPA · n = 149,010 · 2025 Q1–Q4
Median award per line item
$566
mean $1,180 · n = 149,010 · 2025 Q1–Q4
Median QPA
$170
per line item · n = 149,010 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.56x
total awarded ÷ total QPA · n = 149,010 · 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 | 149,010 | $175.8M | $49.4M | $126.4M | $566 | $170 | 3.56x |
| 2024 Q3–Q4 | 33,932 | $44.1M | $6.7M | $37.4M | $463 | $124 | 6.60x |
| 2024 Q3–2025 Q4 | 182,942 | $219.9M | $56.1M | $163.8M | $556 | $163 | 3.92x |
| 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 | 135,766 | 87.3% | 3.59x | 2.46x–6.12x | 133,834 | 34 |
| 2024 Q1–Q4 | 43,373 | 85.7% | 3.94x | 2.58x–5.88x | 42,948 | 61 |
| 2023 Q1–Q4 | 5,573 | 75.4% | 3.23x | 1.52x–5.47x | 5,412 | 96 |
| 2023 Q1–2025 Q4 | 184,712 | 86.6% | 3.63x | 2.45x–6.02x | 182,194 | 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 Indiana
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 68,819 | 86.6% | 2.94x | 67,941 | 31 |
| Radiology | 53,378 | 90.8% | 5.34x | 53,272 | 40 |
| Anesthesiology | 4,999 | 78.0% | 4.25x | 4,947 | 30 |
| Intraoperative neuromonitoring | 3,927 | 86.5% | 16.13x | 3,784 | 33 |
| Neonatology | 1,317 | 88.2% | 3.46x | 1,317 | 47 |
| Not reported / unspecified | 1,086 | 18.3% | 1.05x | 1,015 | 95 |
| Internal and family medicine | 1,042 | 85.8% | 6.80x | 884 | 39.5 |
| Hospitals and facilities | 755 | 85.7% | 1.82x | 330 | 68 |
| Hospital medicine (hospitalists) | 298 | 80.9% | 1.68x | 298 | 32 |
| Other / unclassified labels | 39 | 94.9% | – | 13 | 29 |
| General and other surgery | 35 | 97.1% | – | 1 | 75 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Indiana
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 29,266 | 87.2% | 3.07x | 28,965 | 32 |
| 99285 Emergency department visit with high level of medical decision making | 18,457 | 87.5% | 2.51x | 18,178 | 32 |
| 99283 Emergency department visit with low level of medical decision making | 7,402 | 84.1% | 3.27x | 7,353 | 30 |
| 77067 Screening mammography | 6,177 | 93.0% | 2.72x | 6,152 | 45 |
| 77063 Screening 3D breast mammography | 6,162 | 92.7% | 2.39x | 6,138 | 45 |
| 71045 X-ray of chest, 1 view | 3,600 | 91.3% | 7.28x | 3,597 | 48 |
| 74177 CT scan of abdomen and pelvis with contrast | 3,439 | 88.3% | 6.40x | 3,402 | 35 |
| 71046 X-ray of chest, 2 views | 2,856 | 89.0% | 6.89x | 2,852 | 38 |
| 70450 CT scan head or brain without contrast | 2,366 | 89.4% | 5.52x | 2,345 | 38 |
| 99291 Critical care, first 30-74 minutes | 1,710 | 89.2% | 3.11x | 1,695 | 30 |
| 71275 CT scan of blood vessels of chest with contrast | 1,452 | 90.5% | 6.41x | 1,426 | 38 |
| 76705 Limited ultrasound scan of abdomen | 1,448 | 90.8% | 6.31x | 1,442 | 32 |
| 74176 CT scan of abdomen and pelvis without contrast | 1,323 | 87.5% | 6.37x | 1,317 | 36 |
| 76642 Limited ultrasound scan of 1 breast | 1,323 | 88.4% | 5.35x | 1,323 | 33 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 1,087 | 86.4% | 33.97x † | 1,048 | 38 |
| 87637 Detection test by multiplex amplified probe technique for severe acute respirato | 1,086 | 79.7% | 2.84x | 1,081 | 31 |
| 00812 Anesthesia for exam of colon using an endoscope | 985 | 74.6% | 4.51x | 982 | 31 |
| 76830 Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina | 980 | 89.6% | 5.92x | 974 | 39 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 853 | 87.6% | 12.74x | 815 | 34 |
| 80053 Blood test, comprehensive group of blood chemicals | 750 | 82.1% | 5.04x | 722 | 33 |
| 93971 Ultrasound study of one arm or leg veins with compression and maneuvers | 707 | 92.9% | 8.04x | 705 | 26 |
| 76856 Complete ultrasound scan of pelvis | 688 | 88.2% | 5.57x | 684 | 43 |
| 70498 CT scan of blood vessels of neck with contrast | 685 | 88.5% | 6.14x | 678 | 44 |
| 74018 X-ray of abdomen, 1 view | 673 | 93.2% | 7.28x | 671 | 42 |
| 77065 Diagnostic mammography of 1 breast | 672 | 93.2% | 2.75x | 668 | 66.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Indiana
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 |
|---|---|---|---|---|---|
| UNITED HEALTHCARE (uhc.com) | 42,334 | 86.1% | 4.07x | 42,081 | 43 |
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 35,209 | 85.3% | 2.72x | 34,466 | 30 |
| AETNA (aetna.com) | 17,073 | 93.2% | 4.84x | 17,054 | 27 |
| UMR (clearhs.com) | 16,970 | 91.8% | 4.05x | 16,848 | 35 |
| CIGNA (multiplan.com) | 9,187 | 82.2% | 3.59x | 9,081 | 48 |
| UMR (clearhealthcloud.com) | 5,104 | 88.6% | 3.32x | 5,001 | 39 |
| CARESOURCE MARKETPLACE (caresource.com) | 2,138 | 91.2% | 3.20x | 1,741 | 31 |
| BCBSTX (bcbstx.com) | 1,840 | 87.9% | 16.75x | 1,744 | 33 |
| AMBETTER (centene.com) | 1,787 | 65.5% | 4.09x | 1,744 | 45 |
| CIGNA (cigna.com) | 1,657 | 92.2% | 3.18x | 1,655 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Indiana
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 35,244 | $28.1M | $623 | $190 | 1.27x |
| 99285 Emergency department visit with high level of medical decision making | 22,163 | $20.6M | $685 | $272 | 2.43x |
| 99283 Emergency department visit with low level of medical decision making | 8,415 | $8.4M | $414 | $119 | 3.28x |
| 77067 Screening mammography | 6,315 | $1.2M | $193 | $70 | 2.66x |
| 77063 Screening 3D breast mammography | 6,216 | $797,497 | $130 | $55 | 2.45x |
| 71045 X-ray of chest, 1 view | 3,415 | $371,504 | $107 | $15 | 6.05x |
| 74177 CT scan of abdomen and pelvis with contrast | 3,308 | $5.1M | $1,030 | $166 | 4.60x |
| 71046 X-ray of chest, 2 views | 2,963 | $915,489 | $125 | $18 | 4.50x |
| 70450 CT scan head or brain without contrast | 2,233 | $1.9M | $388 | $72 | 4.36x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 2,198 | $11.2M | $5,016 | $56 | 41.53x |
| 00812 Anesthesia for exam of colon using an endoscope | 2,166 | $2.3M | $960 | $200 | 4.64x |
| 99291 Critical care, first 30-74 minutes | 2,157 | $2.3M | $917 | $295 | 2.90x |
| 76705 Limited ultrasound scan of abdomen | 1,385 | $470,153 | $294 | $48 | 5.92x |
| 71275 CT scan of blood vessels of chest with contrast | 1,374 | $1.6M | $1,014 | $168 | 4.77x |
| 76642 Limited ultrasound scan of 1 breast | 1,313 | $416,025 | $299 | $60 | 5.28x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 1,304 | $8.4M | $7,249 | $141 | 20.89x |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 1,274 | $7.1M | $7,310 | $58 | 30.27x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 1,226 | $16.7M | $8,000 | $245 | 19.03x |
| 74176 CT scan of abdomen and pelvis without contrast | 1,198 | $1.5M | $984 | $158 | 4.65x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 1,123 | $4.8M | $3,446 | $111 | 25.68x |
| 87637 Detection test by multiplex amplified probe technique for severe acute respirato | 1,035 | $687,721 | $750 | $203 | 3.03x |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 915 | $986,268 | $581 | $178 | 4.61x |
| 76830 Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina | 875 | $323,524 | $319 | $54 | 5.43x |
| 00840 Anesthesia for other procedure on lower abdomen | 809 | $1.6M | $963 | $425 | 3.83x |
| 80053 Blood test, comprehensive group of blood chemicals | 714 | $530,738 | $824 | $131 | 4.08x |
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 Indiana?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.3% of 135,766 determined dispute line items for services provided in Indiana. 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 Indiana?
In 2025 Q1–Q4, the median prevailing offer was 3.59x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.46x to 6.12x (n = 133,834 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 Indiana?
In 2025 Q1–Q4, the median was 34 business days (n = 135,766 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Indiana figures count line items whose place of service was Indiana. See methodology for caveats.