Federal IDR outcomes in Maryland
In 2025 Q1–Q4, the provider or facility offer prevailed in 79.4% of 22,427 determined Federal IDR dispute line items for services provided in Maryland. The median prevailing offer was 3.74x the QPA (25th–75th percentile 2.40x–11.21x; n = 21,759). The median time to a decision was 38 business days (n = 22,427).
Determined line items
22,427
2025 Q1–Q4 · 11 split decisions excluded
Provider win rate
79.4%
n = 22,427 · 2025 Q1–Q4
Median payment vs QPA
3.74x
middle half 2.40x–11.21x · n = 21,759 · 2025 Q1–Q4
Median days to decision
38
business days, from dispute initiation · n = 22,427 · 2025 Q1–Q4
Dollar amounts
Total awarded
$74.5M
sum of prevailing offers · n = 39,487 · 2025 Q1–Q4
Total QPA
$19.6M
sum of QPAs, same line items · n = 39,487 · 2025 Q1–Q4
Awarded above QPA
$54.9M
total awarded minus total QPA · n = 39,487 · 2025 Q1–Q4
Median award per line item
$836
mean $1,888 · n = 39,487 · 2025 Q1–Q4
Median QPA
$213
per line item · n = 39,487 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.81x
total awarded ÷ total QPA · n = 39,487 · 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 | 39,487 | $74.5M | $19.6M | $54.9M | $836 | $213 | 3.81x |
| 2024 Q3–Q4 | 16,719 | $22.0M | $16.8M | $5.2M | $581 | $174 | 1.31x |
| 2024 Q3–2025 Q4 | 56,206 | $96.5M | $36.4M | $60.1M | $713 | $203 | 2.65x |
| 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 | 22,427 | 79.4% | 3.74x | 2.40x–11.21x | 21,759 | 38 |
| 2024 Q1–Q4 | 8,469 | 80.7% | 3.08x | 2.48x–4.56x | 8,181 | 162 |
| 2023 Q1–Q4 | 939 | 59.4% | 2.91x | 1.00x–4.58x | 862 | 45 |
| 2023 Q1–2025 Q4 | 31,835 | 79.2% | 3.30x | 2.40x–7.47x | 30,802 | 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 Maryland
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 13,345 | 82.5% | 3.27x | 13,218 | 42 |
| Anesthesiology | 1,499 | 87.9% | 6.00x | 1,476 | 31 |
| Not reported / unspecified | 1,448 | 10.2% | 1.00x | 1,439 | 28 |
| Neonatology | 1,341 | 87.2% | 4.40x | 1,340 | 39 |
| Internal and family medicine | 1,298 | 89.8% | 7.14x | 1,296 | 34 |
| Intraoperative neuromonitoring | 1,259 | 87.9% | 24.96x † | 944 | 28 |
| General and other surgery | 655 | 78.2% | 8.27x | 474 | 31 |
| Laboratory and pathology | 654 | 80.1% | 4.02x | 654 | 40 |
| Radiology | 588 | 100.0% | 2.06x | 588 | 42 |
| Hospital medicine (hospitalists) | 130 | 86.9% | 6.12x | 130 | 41 |
| Orthopedic surgery | 108 | 88.9% | 46.24x † | 108 | 32 |
| Other / unclassified labels | 58 | 53.4% | 6.51x | 48 | 26 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Maryland
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99285 Emergency department visit with high level of medical decision making | 6,118 | 82.1% | 3.06x | 6,052 | 42 |
| 99284 Emergency department visit with moderate level of medical decision making | 4,922 | 80.4% | 3.36x | 4,909 | 41.5 |
| 99283 Emergency department visit with low level of medical decision making | 1,793 | 32.8% | 1.00x | 1,793 | 30 |
| 99291 Critical care, first 30-74 minutes | 1,327 | 83.4% | 3.85x | 1,325 | 49 |
| 88305 Pathology examination of tissue using a microscope, intermediate complexity | 630 | 77.0% | 4.02x | 630 | 40 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 428 | 87.1% | 6.21x | 428 | 34 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 349 | 85.7% | 61.99x † | 271 | 28 |
| 99239 Hospital discharge day management, more than 30 minutes | 346 | 86.1% | 7.12x | 346 | 35 |
| 00812 Anesthesia for exam of colon using an endoscope | 335 | 82.1% | 5.11x | 335 | 27 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 273 | 93.0% | 6.65x | 272 | 32 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 270 | 89.6% | 10.96x | 202 | 27 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 230 | 92.2% | 6.80x | 230 | 37 |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 193 | 79.8% | 4.40x | 193 | 34 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 189 | 93.7% | 21.53x † | 157 | 30 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 185 | 87.0% | 6.40x | 184 | 32 |
| 99238 Hospital discharge day management, 30 minutes or less | 184 | 80.4% | 4.65x | 183 | 47.5 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 176 | 84.7% | 40.46x † | 133 | 27 |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 172 | 89.0% | 3.30x | 172 | 42 |
| 99472 Follow-up inpatient hospital critical care of infant or young child per day (29 | 156 | 76.9% | 5.00x | 156 | 36 |
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 145 | 95.2% | 5.05x | 145 | 44 |
| 71046 X-ray of chest, 2 views | 125 | 100.0% | 2.22x | 125 | 42 |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 121 | 90.1% | 5.15x | 121 | 27 |
| 00790 Anesthesia for other procedure on upper abdomen | 114 | 78.9% | 6.64x | 114 | 36 |
| 58662 Destruction or removal of ovary or growth of pelvis using an endoscope | 111 | 73.0% | 8.44x | 86 | 26 |
| 00840 Anesthesia for other procedure on lower abdomen | 110 | 88.2% | 8.06x | 110 | 35 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Maryland
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) | 6,833 | 75.6% | 2.78x | 6,711 | 45 |
| CAREFIRST (carefirst.com) | 6,072 | 89.5% | 13.84x | 5,971 | 32 |
| CIGNA (multiplan.com) | 5,255 | 65.5% | 2.84x | 5,225 | 44 |
| AETNA (aetna.com) | 1,267 | 91.6% | 3.08x | 1,130 | 34 |
| UNITED HEALTHCARE (uhc.com) | 1,062 | 75.3% | 3.68x | 1,009 | 40 |
| CIGNA (zelis.com) | 594 | 98.3% | 4.02x | 575 | 288 |
| UMR (clearhs.com) | 295 | 78.3% | 4.47x | 261 | 26 |
| BCBS OF NEW MEXICO (hsd.nm.gov) | 225 | 100.0% | 60.59x † | 191 | 26 |
| KAISER FOUNDATION (kp.org) | 217 | 100.0% | 4.64x | 213 | 26 |
| BCBSTX (bcbstx.com) | 122 | 85.2% | 43.80x † | 81 | 28 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Maryland
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 8,975 | $7.3M | $613 | $189 | 0.79x |
| 99285 Emergency department visit with high level of medical decision making | 7,728 | $9.8M | $836 | $264 | 3.64x |
| 99283 Emergency department visit with low level of medical decision making | 2,325 | $930,809 | $220 | $134 | 2.72x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 2,061 | $5.4M | $1,817 | $53 | 23.90x |
| 99291 Critical care, first 30-74 minutes | 1,679 | $2.5M | $1,325 | $340 | 4.06x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 1,436 | $4.3M | $2,229 | $139 | 16.35x |
| 00812 Anesthesia for exam of colon using an endoscope | 1,352 | $1.9M | $1,698 | $353 | 3.66x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 1,000 | $6.3M | $3,550 | $439 | 8.33x |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 518 | $882,029 | $1,890 | $363 | 4.17x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 505 | $368,451 | $718 | $118 | 4.42x |
| 88305 Pathology examination of tissue using a microscope, intermediate complexity | 484 | $81,508 | $98 | $25 | 3.20x |
| 00840 Anesthesia for other procedure on lower abdomen | 446 | $1.6M | $3,692 | $625 | 5.15x |
| 01400 Anesthesia for other procedure or exam of knee joint using an endoscope | 398 | $1.1M | $2,816 | $327 | 7.39x |
| 01480 Anesthesia for other procedure on lower leg, ankle, and foot bones | 354 | $913,834 | $2,723 | $339 | 6.90x |
| 00813 Anesthesia for procedure on small and large bowel using an endoscope | 352 | $658,034 | $2,041 | $411 | 3.88x |
| 00811 Anesthesia for other procedure on large bowel using an endoscope | 299 | $457,164 | $1,698 | $339 | 4.16x |
| 99239 Hospital discharge day management, more than 30 minutes | 299 | $252,362 | $737 | $115 | 6.89x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 297 | $187,164 | $434 | $81 | 7.14x |
| 00790 Anesthesia for other procedure on upper abdomen | 283 | $1.1M | $3,962 | $668 | 2.89x |
| 95870 Needle measurement of electrical activity in arm, leg, trunk or head muscles, li | 261 | $370,515 | $414 | $50 | 15.45x |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 257 | $325,017 | $1,389 | $213 | 5.68x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 248 | $923,418 | $3,446 | $108 | 20.81x |
| 01967 Anesthesia for labor during planned vaginal delivery | 204 | $1.1M | $6,450 | $2,511 | 2.23x |
| 00400 Anesthesia for other procedure on skin of arms, legs, and front body | 200 | $408,522 | $2,112 | $314 | 6.13x |
| 01630 Anesthesia for other procedure on top of arm bone and shoulder joint | 198 | $672,316 | $3,240 | $404 | 8.03x |
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 Maryland?
In 2025 Q1–Q4, the provider or facility offer was selected in 79.4% of 22,427 determined dispute line items for services provided in Maryland. 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 Maryland?
In 2025 Q1–Q4, the median prevailing offer was 3.74x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.40x to 11.21x (n = 21,759 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 Maryland?
In 2025 Q1–Q4, the median was 38 business days (n = 22,427 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Maryland figures count line items whose place of service was Maryland. See methodology for caveats.