Federal IDR outcomes in Louisiana
In 2025 Q1–Q4, the provider or facility offer prevailed in 76.1% of 82,853 determined Federal IDR dispute line items for services provided in Louisiana. The median prevailing offer was 3.81x the QPA (25th–75th percentile 1.86x–5.79x; n = 81,326). The median time to a decision was 32 business days (n = 82,853).
Determined line items
82,853
2025 Q1–Q4 · 84 split decisions excluded
Provider win rate
76.1%
n = 82,853 · 2025 Q1–Q4
Median payment vs QPA
3.81x
middle half 1.86x–5.79x · n = 81,326 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 82,853 · 2025 Q1–Q4
Dollar amounts
Total awarded
$77.2M
sum of prevailing offers · n = 69,504 · 2025 Q1–Q4
Total QPA
$20.3M
sum of QPAs, same line items · n = 69,504 · 2025 Q1–Q4
Awarded above QPA
$56.9M
total awarded minus total QPA · n = 69,504 · 2025 Q1–Q4
Median award per line item
$685
mean $1,110 · n = 69,504 · 2025 Q1–Q4
Median QPA
$171
per line item · n = 69,504 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.80x
total awarded ÷ total QPA · n = 69,504 · 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 | 69,504 | $77.2M | $20.3M | $56.9M | $685 | $171 | 3.80x |
| 2024 Q3–Q4 | 7,792 | $7.8M | $25.9M | −$18.1M | $742 | $177 | 0.30x |
| 2024 Q3–2025 Q4 | 77,296 | $85.0M | $46.2M | $38.8M | $685 | $175 | 1.84x |
| 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 | 82,853 | 76.1% | 3.81x | 1.86x–5.79x | 81,326 | 32 |
| 2024 Q1–Q4 | 14,860 | 77.8% | 5.07x | 2.93x–5.70x | 14,681 | 83 |
| 2023 Q1–Q4 | 4,164 | 71.8% | 4.24x | 1.39x–5.56x | 4,029 | 95 |
| 2023 Q1–2025 Q4 | 101,877 | 76.2% | 3.89x | 1.94x–5.70x | 100,036 | 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 Louisiana
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 68,442 | 77.2% | 3.85x | 67,595 | 31 |
| Anesthesiology | 5,894 | 59.4% | 8.39x | 5,623 | 84 |
| Hospital medicine (hospitalists) | 2,899 | 87.4% | 3.23x | 2,839 | 26 |
| Radiology | 2,258 | 92.1% | 1.64x | 2,255 | 43 |
| Not reported / unspecified | 964 | 19.1% | 1.26x | 735 | 35 |
| Intraoperative neuromonitoring | 897 | 77.9% | 21.42x † | 802 | 31 |
| Hospitals and facilities | 464 | 86.6% | 1.00x | 453 | 20 |
| Neonatology | 311 | 88.4% | 2.01x | 311 | 128 |
| Internal and family medicine | 268 | 73.9% | 9.14x | 267 | 37 |
| Plastic and reconstructive surgery | 139 | 90.6% | 11.08x | 137 | 32 |
| Infectious disease | 87 | 100.0% | 5.11x | 84 | 17 |
| Laboratory and pathology | 74 | 64.9% | 1.00x | 73 | 183 |
| Surgical assistant services | 73 | 42.5% | 1.09x | 69 | 42 |
| Neurology | 42 | 71.4% | 14.20x | 42 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Louisiana
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 30,322 | 81.8% | 3.79x | 29,925 | 32 |
| 99285 Emergency department visit with high level of medical decision making | 14,486 | 82.5% | 3.81x | 14,148 | 37 |
| 99283 Emergency department visit with low level of medical decision making | 4,270 | 71.7% | 3.71x | 4,245 | 35 |
| 99291 Critical care, first 30-74 minutes | 2,557 | 86.0% | 2.04x | 2,515 | 29 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 1,197 | 84.0% | 4.95x | 1,149 | 24 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 900 | 87.2% | 5.20x | 891 | 30 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 854 | 81.5% | 2.87x | 841 | 26.5 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 797 | 85.3% | 4.47x | 784 | 31 |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 793 | 56.7% | 3.98x | 793 | 25 |
| 81003 Automated urinalysis test | 699 | 60.7% | 4.18x | 690 | 27 |
| 99239 Hospital discharge day management, more than 30 minutes | 601 | 87.5% | 2.94x | 599 | 25 |
| 71046 X-ray of chest, 2 views | 571 | 72.9% | 3.59x | 566 | 32 |
| 80053 Blood test, comprehensive group of blood chemicals | 569 | 61.2% | 4.86x | 556 | 28 |
| 00170 Anesthesia for other procedure on mouth | 521 | 55.1% | 8.02x | 503 | 79 |
| 71045 X-ray of chest, 1 view | 508 | 86.4% | 2.00x | 500 | 32 |
| 01938 Anesthesia for injection, drainage or aspiration procedures on spine or spinal c | 480 | 61.9% | 9.82x | 456 | 83 |
| 96361 Infusion into a vein for hydration, each additional hour | 461 | 58.1% | 5.65x | 451 | 26 |
| 96374 Injection of drug or substance into vein | 441 | 59.6% | 7.70x | 440 | 27 |
| 64415 Injection of anesthetic agent and/or steroid into arm nerve bundle (brachial ple | 431 | 64.3% | 13.46x | 410 | 96 |
| 82550 Creatine kinase (cardiac enzyme) level, total | 426 | 58.7% | 5.30x | 425 | 27 |
| 82150 Amylase (enzyme) level | 424 | 57.8% | 5.52x | 424 | 27 |
| 80051 Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) | 418 | 58.1% | 5.42x | 418 | 27 |
| 84520 Urea nitrogen level to assess kidney function, quantitative | 412 | 58.5% | 3.62x | 412 | 27 |
| 82565 Blood creatinine level | 410 | 58.3% | 4.53x | 410 | 27 |
| 82947 Blood glucose (sugar) level | 409 | 57.9% | 3.33x | 409 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Louisiana
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) | 33,720 | 86.6% | 3.77x | 33,065 | 31 |
| BCBSLA (lablue.com) | 22,110 | 49.1% | 3.62x | 21,975 | 36 |
| CIGNA (multiplan.com) | 8,603 | 82.5% | 5.47x | 8,334 | 48 |
| UMR (clearhs.com) | 8,584 | 85.0% | 3.51x | 8,468 | 29 |
| AMBETTER (centene.com) | 3,908 | 96.5% | 2.47x | 3,707 | 25 |
| BLUE CROSS BLUE SHIELD OF LOUISIANA (bcbsla.com) | 1,544 | 56.6% | 5.64x | 1,506 | 91 |
| AETNA (aetna.com) | 1,303 | 92.6% | 7.18x | 1,278 | 26 |
| UMR (clearhealthcloud.com) | 689 | 88.5% | 3.86x | 680 | 29 |
| CIGNA (cigna.com) | 289 | 86.5% | 5.18x | 285 | 36 |
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 261 | 90.8% | 5.04x | 254 | 78 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Louisiana
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 27,902 | $27.4M | $685 | $171 | 3.73x |
| 99285 Emergency department visit with high level of medical decision making | 12,830 | $18.3M | $1,001 | $255 | 2.73x |
| 99283 Emergency department visit with low level of medical decision making | 3,984 | $5.1M | $590 | $121 | 3.84x |
| 99291 Critical care, first 30-74 minutes | 2,241 | $2.8M | $616 | $315 | 3.44x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 1,015 | $809,175 | $616 | $124 | 5.90x |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 774 | $74,374 | $96 | $12 | 6.46x |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 761 | $119,874 | $225 | $32 | 3.38x |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 739 | $790,584 | $675 | $238 | 4.35x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 658 | $442,011 | $315 | $85 | 7.80x |
| 81003 Automated urinalysis test | 621 | $73,504 | $194 | $25 | 3.55x |
| 99239 Hospital discharge day management, more than 30 minutes | 527 | $277,017 | $411 | $131 | 3.76x |
| 71046 X-ray of chest, 2 views | 490 | $300,660 | $178 | $90 | 5.08x |
| 80053 Blood test, comprehensive group of blood chemicals | 488 | $276,381 | $824 | $100 | 4.58x |
| 00170 Anesthesia for other procedure on mouth | 479 | $691,402 | $1,800 | $205 | 6.43x |
| 71045 X-ray of chest, 1 view | 449 | $87,529 | $26 | $15 | 5.21x |
| 01938 Anesthesia for injection, drainage or aspiration procedures on spine or spinal c | 431 | $541,037 | $1,716 | $161 | 6.15x |
| 96361 Infusion into a vein for hydration, each additional hour | 395 | $296,237 | $354 | $54 | 6.29x |
| 96374 Injection of drug or substance into vein | 392 | $169,192 | $454 | $50 | 6.36x |
| 64415 Injection of anesthetic agent and/or steroid into arm nerve bundle (brachial ple | 388 | $476,231 | $1,788 | $133 | 7.46x |
| 80051 Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) | 387 | $98,926 | $421 | $44 | 5.04x |
| 82550 Creatine kinase (cardiac enzyme) level, total | 387 | $64,515 | $265 | $26 | 4.47x |
| 82150 Amylase (enzyme) level | 384 | $72,185 | $318 | $31 | 4.58x |
| 80076 Liver function blood test panel | 380 | $95,666 | $430 | $43 | 4.50x |
| 84520 Urea nitrogen level to assess kidney function, quantitative | 380 | $45,261 | $193 | $25 | 3.77x |
| 82947 Blood glucose (sugar) level | 377 | $38,724 | $167 | $25 | 3.64x |
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 Louisiana?
In 2025 Q1–Q4, the provider or facility offer was selected in 76.1% of 82,853 determined dispute line items for services provided in Louisiana. 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 Louisiana?
In 2025 Q1–Q4, the median prevailing offer was 3.81x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.86x to 5.79x (n = 81,326 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 Louisiana?
In 2025 Q1–Q4, the median was 32 business days (n = 82,853 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Louisiana figures count line items whose place of service was Louisiana. See methodology for caveats.