Federal IDR outcomes in Kansas
In 2025 Q1–Q4, the provider or facility offer prevailed in 91.7% of 35,612 determined Federal IDR dispute line items for services provided in Kansas. The median prevailing offer was 3.50x the QPA (25th–75th percentile 1.88x–7.30x; n = 31,835). The median time to a decision was 30 business days (n = 35,612).
Determined line items
35,612
2025 Q1–Q4 · 26 split decisions excluded
Provider win rate
91.7%
n = 35,612 · 2025 Q1–Q4
Median payment vs QPA
3.50x
middle half 1.88x–7.30x · n = 31,835 · 2025 Q1–Q4
Median days to decision
30
business days, from dispute initiation · n = 35,612 · 2025 Q1–Q4
Dollar amounts
Total awarded
$36.1M
sum of prevailing offers · n = 27,129 · 2025 Q1–Q4
Total QPA
$18.5M
sum of QPAs, same line items · n = 27,129 · 2025 Q1–Q4
Awarded above QPA
$17.6M
total awarded minus total QPA · n = 27,129 · 2025 Q1–Q4
Median award per line item
$500
mean $1,330 · n = 27,129 · 2025 Q1–Q4
Median QPA
$151
per line item · n = 27,129 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
1.95x
total awarded ÷ total QPA · n = 27,129 · 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 | 27,129 | $36.1M | $18.5M | $17.6M | $500 | $151 | 1.95x |
| 2024 Q3–Q4 | 7,349 | $10.6M | $2.2M | $8.4M | $529 | $190 | 4.84x |
| 2024 Q3–2025 Q4 | 34,478 | $46.7M | $20.7M | $26.0M | $509 | $159 | 2.26x |
| 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 | 35,612 | 91.7% | 3.50x | 1.88x–7.30x | 31,835 | 30 |
| 2024 Q1–Q4 | 6,989 | 85.3% | 2.33x | 1.17x–6.47x | 4,917 | 38 |
| 2023 Q1–Q4 | 389 | 89.7% | 1.26x | 1.13x–3.40x | 330 | 50 |
| 2023 Q1–2025 Q4 | 42,990 | 90.7% | 3.34x | 1.64x–7.13x | 37,082 | 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 Kansas
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 24,988 | 94.2% | 3.50x | 24,464 | 28 |
| Hospitals and facilities | 6,615 | 88.5% | 2.56x | 4,560 | 42 |
| Intraoperative neuromonitoring | 2,185 | 85.2% | 23.81x † | 1,119 | 34 |
| Radiology | 617 | 76.5% | 1.62x | 617 | 55 |
| Anesthesiology | 572 | 87.8% | 8.58x | 561 | 26 |
| Not reported / unspecified | 225 | 22.7% | 1.20x | 127 | 37 |
| General and other surgery | 170 | 93.5% | 4.23x | 149 | 40.5 |
| Internal and family medicine | 104 | 93.3% | 8.68x | 103 | 32.5 |
| Neonatology | 83 | 94.0% | 3.58x | 83 | 19 |
| Other / unclassified labels | 45 | 75.6% | 1.08x | 44 | 83 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Kansas
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 6,964 | 93.2% | 3.76x | 6,835 | 27 |
| 99285 Emergency department visit with high level of medical decision making | 4,829 | 94.0% | 2.36x | 4,719 | 28 |
| 99283 Emergency department visit with low level of medical decision making | 2,382 | 89.1% | 4.87x | 2,359 | 28.5 |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 646 | 93.0% | 1.31x | 626 | 29 |
| 96374 Injection of drug or substance into vein | 619 | 92.6% | 2.33x | 548 | 31 |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 617 | 95.1% | 1.31x | 612 | 25 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 601 | 88.9% | 1.31x | 522 | 57 |
| 81003 Automated urinalysis test | 597 | 93.5% | 1.31x | 578 | 29 |
| 80053 Blood test, comprehensive group of blood chemicals | 589 | 90.7% | 1.89x | 507 | 34 |
| 96375 Injection of additional new drug or substance into vein | 584 | 92.8% | 6.40x | 529 | 30 |
| 96361 Infusion into a vein for hydration, each additional hour | 531 | 93.4% | 3.12x | 474 | 29 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 478 | 92.9% | 4.32x | 424 | 35 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 461 | 85.2% | 38.87x † | 260 | 37 |
| 74177 CT scan of abdomen and pelvis with contrast | 453 | 87.0% | 5.07x | 425 | 38 |
| 36415 Insertion of needle into vein for collection of blood sample | 447 | 93.3% | 1.31x | 225 | 34 |
| 84484 Troponin (protein) analysis, quantitative | 430 | 90.7% | 1.31x | 381 | 34 |
| 82150 Amylase (enzyme) level | 390 | 93.6% | 1.31x | 390 | 28 |
| 82977 Glutamyltransferase (liver enzyme) level | 388 | 93.6% | 1.31x | 388 | 28.5 |
| 80076 Liver function blood test panel | 381 | 93.2% | 1.31x | 380 | 29 |
| 71045 X-ray of chest, 1 view | 339 | 81.7% | 2.32x | 315 | 44 |
| 71046 X-ray of chest, 2 views | 334 | 93.4% | 9.35x | 330 | 33 |
| 99291 Critical care, first 30-74 minutes | 324 | 93.5% | 3.44x | 319 | 30 |
| 87428 Detection test by immunoassay technique for severe acute respiratory syndrome co | 321 | 94.4% | 4.29x | 308 | 37 |
| 81025 Urine pregnancy test | 311 | 93.6% | 1.31x | 277 | 31 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 291 | 85.6% | 32.17x † | 123 | 33 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Kansas
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 |
|---|---|---|---|---|---|
| BCBS KANSAS (bcbsks.com) | 14,094 | 98.5% | 2.85x | 14,066 | 27 |
| AMBETTER (centene.com) | 3,414 | 93.8% | 3.50x | 3,186 | 30 |
| AETNA (aetna.com) | 3,120 | 95.1% | 3.44x | 2,570 | 32 |
| OSCAR (hioscar.com) | 3,026 | 90.2% | 4.65x | 2,693 | 31 |
| CIGNA (cigna.com) | 2,988 | 79.2% | 2.12x | 2,495 | 35 |
| UNITED HEALTHCARE (uhc.com) | 2,289 | 75.9% | 3.44x | 1,928 | 35 |
| UMR (clearhs.com) | 1,687 | 82.9% | 5.97x | 1,586 | 31 |
| BCBSTX (bcbstx.com) | 1,198 | 93.8% | 9.34x | 674 | 39 |
| CIGNA (multiplan.com) | 445 | 82.0% | 3.96x | 303 | 35 |
| BLUE CROSS BLUE SHIELD OF KANSAS CITY (bluekc.com) | 415 | 82.7% | 3.00x | 332 | 34 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Kansas
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 5,014 | $6.8M | $698 | $195 | 3.39x |
| 99285 Emergency department visit with high level of medical decision making | 3,195 | $5.8M | $1,163 | $309 | 3.01x |
| 99283 Emergency department visit with low level of medical decision making | 1,549 | $2.4M | $1,429 | $345 | 3.62x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 907 | $229,601 | $279 | $41 | 3.97x |
| 71045 X-ray of chest, 1 view | 670 | $185,335 | $323 | $57 | 3.13x |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 660 | $210,115 | $310 | $86 | 3.13x |
| 84484 Troponin (protein) analysis, quantitative | 534 | $169,972 | $338 | $84 | 3.91x |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 531 | $295,649 | $545 | $133 | 2.83x |
| 01400 Anesthesia for other procedure or exam of knee joint using an endoscope | 462 | $1.3M | $2,776 | $321 | 7.83x |
| 74177 CT scan of abdomen and pelvis with contrast | 459 | $1.3M | $265 | $135 | 0.12x |
| 80053 Blood test, comprehensive group of blood chemicals | 447 | $213,394 | $428 | $54 | 3.63x |
| 01630 Anesthesia for other procedure on top of arm bone and shoulder joint | 377 | $1.2M | $3,218 | $362 | 6.40x |
| 00812 Anesthesia for exam of colon using an endoscope | 376 | $714,217 | $2,156 | $219 | 7.58x |
| 96374 Injection of drug or substance into vein | 367 | $190,626 | $454 | $98 | 3.97x |
| 81003 Automated urinalysis test | 320 | $44,783 | $104 | $35 | 3.14x |
| 96361 Infusion into a vein for hydration, each additional hour | 305 | $216,322 | $351 | $92 | 3.68x |
| 83690 Lipase (fat enzyme) level | 298 | $82,893 | $287 | $28 | 5.16x |
| 96375 Injection of additional new drug or substance into vein | 297 | $167,244 | $308 | $102 | 3.68x |
| 01810 Anesthesia for procedure on nerves, muscles, tendons, and tissue of forearm, wri | 288 | $524,828 | $1,798 | $187 | 8.44x |
| 99291 Critical care, first 30-74 minutes | 277 | $386,345 | $894 | $291 | 3.73x |
| 70450 CT scan head or brain without contrast | 265 | $719,906 | $3,176 | $292 | 4.26x |
| 01480 Anesthesia for other procedure on lower leg, ankle, and foot bones | 262 | $674,106 | $2,640 | $287 | 7.91x |
| 81001 Manual urinalysis test with examination using microscope, automated | 257 | $66,012 | $287 | $18 | 6.27x |
| 81025 Urine pregnancy test | 248 | $40,245 | $148 | $43 | 2.68x |
| 00142 Anesthesia for lens surgery | 222 | $390,861 | $1,916 | $201 | 8.57x |
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 Kansas?
In 2025 Q1–Q4, the provider or facility offer was selected in 91.7% of 35,612 determined dispute line items for services provided in Kansas. 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 Kansas?
In 2025 Q1–Q4, the median prevailing offer was 3.50x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.88x to 7.30x (n = 31,835 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 Kansas?
In 2025 Q1–Q4, the median was 30 business days (n = 35,612 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Kansas figures count line items whose place of service was Kansas. See methodology for caveats.