Federal IDR outcomes in Michigan
In 2025 Q1–Q4, the provider or facility offer prevailed in 93.0% of 43,925 determined Federal IDR dispute line items for services provided in Michigan. The median prevailing offer was 3.91x the QPA (25th–75th percentile 2.42x–6.81x; n = 25,208). The median time to a decision was 33 business days (n = 43,925).
Determined line items
43,925
2025 Q1–Q4 · 12 split decisions excluded
Provider win rate
93.0%
n = 43,925 · 2025 Q1–Q4
Median payment vs QPA
3.91x
middle half 2.42x–6.81x · n = 25,208 · 2025 Q1–Q4
Median days to decision
33
business days, from dispute initiation · n = 43,925 · 2025 Q1–Q4
Dollar amounts
Total awarded
$15.9M
sum of prevailing offers · n = 13,232 · 2025 Q1–Q4
Total QPA
$3.9M
sum of QPAs, same line items · n = 13,232 · 2025 Q1–Q4
Awarded above QPA
$12.0M
total awarded minus total QPA · n = 13,232 · 2025 Q1–Q4
Median award per line item
$664
mean $1,202 · n = 13,232 · 2025 Q1–Q4
Median QPA
$200
per line item · n = 13,232 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
4.08x
total awarded ÷ total QPA · n = 13,232 · 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 | 13,232 | $15.9M | $3.9M | $12.0M | $664 | $200 | 4.08x |
| 2024 Q3–Q4 | 2,680 | $2.5M | $797,558 | $1.7M | $581 | $190 | 3.13x |
| 2024 Q3–2025 Q4 | 15,912 | $18.4M | $4.7M | $13.7M | $621 | $194 | 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 | 43,925 | 93.0% | 3.91x | 2.42x–6.81x | 25,208 | 33 |
| 2024 Q1–Q4 | 11,323 | 90.4% | 3.00x | 2.00x–3.66x | 4,720 | 30 |
| 2023 Q1–Q4 | 278 | 79.9% | 3.12x | 2.24x–3.19x | 220 | 25 |
| 2023 Q1–2025 Q4 | 55,526 | 92.4% | 3.69x | 2.33x–6.51x | 30,148 | 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 Michigan
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Hospitals and facilities | 19,304 | 94.9% | 3.22x | 6,548 | 36 |
| Emergency medicine and emergency departments | 11,519 | 89.8% | 3.15x | 9,244 | 35 |
| Intraoperative neuromonitoring | 5,161 | 92.3% | 29.39x † | 1,840 | 33 |
| Anesthesiology | 3,938 | 94.4% | 7.42x | 3,932 | 35 |
| Radiology | 2,910 | 98.2% | 4.32x | 2,910 | 22 |
| Not reported / unspecified | 946 | 74.3% | 6.81x | 593 | 34 |
| Internal and family medicine | 88 | 95.5% | 5.76x | 88 | 42.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Michigan
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 6,249 | 89.0% | 3.38x | 5,164 | 35 |
| 99285 Emergency department visit with high level of medical decision making | 4,784 | 90.2% | 2.51x | 3,758 | 35 |
| 99283 Emergency department visit with low level of medical decision making | 967 | 90.8% | 3.96x | 780 | 33 |
| 36415 Insertion of needle into vein for collection of blood sample | 960 | 94.8% | 2.96x | 139 | 34 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 869 | 94.7% | 2.80x | 124 | 34 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 833 | 92.0% | 56.76x † | 401 | 30 |
| 95937 Testing of nerve-muscle junction | 758 | 93.0% | 26.96x † | 133 | 36 |
| 71045 X-ray of chest, 1 view | 677 | 98.2% | 4.25x | 630 | 22 |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 616 | 94.8% | 3.14x | 70 | 28 |
| 99291 Critical care, first 30-74 minutes | 543 | 87.8% | 3.70x | 435 | 30 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 493 | 91.9% | 15.13x | 273 | 29 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 492 | 93.1% | 28.13x † | 183 | 32.5 |
| 96374 Injection of drug or substance into vein | 482 | 94.8% | 2.57x | 390 | 37 |
| 95867 Needle measurement of electrical activity in muscles on side of body | 478 | 93.7% | 82.05x † | 78 | 41 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 446 | 89.0% | 13.20x | 228 | 32.5 |
| 71046 X-ray of chest, 2 views | 426 | 97.7% | 4.34x | 389 | 22 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 420 | 94.0% | 2.00x | 63 | 34 |
| 00812 Anesthesia for exam of colon using an endoscope | 408 | 93.6% | 8.17x | 408 | 36 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 404 | 99.5% | 4.74x | 396 | 25 |
| 96361 Infusion into a vein for hydration, each additional hour | 397 | 94.2% | 4.39x | 301 | 36 |
| 00840 Anesthesia for other procedure on lower abdomen | 392 | 92.9% | 7.23x | 391 | 37.5 |
| 96375 Injection of additional new drug or substance into vein | 377 | 94.7% | 5.14x | 293 | 36 |
| 96372 Injection of drug or substance under skin or into muscle | 370 | 95.7% | – | 26 | 37 |
| 74177 CT scan of abdomen and pelvis with contrast | 363 | 98.1% | 4.34x | 330 | 22 |
| 81025 Urine pregnancy test | 358 | 95.0% | 2.00x | 36 | 30.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Michigan
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 |
|---|---|---|---|---|---|
| AMBETTER (centene.com) | 14,412 | 97.8% | 4.39x | 4,255 | 34 |
| BCBS OF MICHIGAN (bcbsm.com) | 8,874 | 96.4% | 4.38x | 6,594 | 26 |
| UNITED HEALTHCARE (uhc.com) | 5,324 | 81.1% | 3.57x | 3,495 | 41 |
| CIGNA (multiplan.com) | 3,793 | 82.3% | 4.43x | 3,483 | 41 |
| AETNA (aetna.com) | 2,786 | 93.1% | 4.75x | 1,560 | 25 |
| UMR (clearhs.com) | 1,693 | 89.5% | 2.58x | 1,133 | 32 |
| UMR (clearhealthcloud.com) | 1,430 | 94.4% | 2.86x | 1,329 | 38 |
| PRIORITY HEALTH (priorityhealth.com) | 1,427 | 99.6% | 4.67x | 1,202 | 30 |
| MOLINA HEALTHCARE (molinahealthcare.com) | 995 | 93.1% | 2.81x | 167 | 74 |
| BCBSTX (bcbstx.com) | 605 | 85.8% | 17.67x | 383 | 37 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Michigan
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 4,331 | $3.1M | $621 | $182 | 3.06x |
| 99285 Emergency department visit with high level of medical decision making | 2,897 | $3.3M | $848 | $275 | 2.70x |
| 99283 Emergency department visit with low level of medical decision making | 508 | $298,007 | $412 | $104 | 3.99x |
| 99291 Critical care, first 30-74 minutes | 375 | $404,686 | $978 | $287 | 2.67x |
| 96374 Injection of drug or substance into vein | 256 | $151,285 | $433 | $170 | 1.98x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 193 | $795,003 | $2,560 | $66 | 56.20x |
| 96361 Infusion into a vein for hydration, each additional hour | 188 | $54,752 | $182 | $68 | 2.56x |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 184 | $9,585 | $56 | $12 | 4.77x |
| 96375 Injection of additional new drug or substance into vein | 182 | $58,319 | $192 | $75 | 3.48x |
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 181 | $106,870 | $635 | $187 | 3.19x |
| 00840 Anesthesia for other procedure on lower abdomen | 168 | $662,933 | $4,005 | $584 | 6.25x |
| 00812 Anesthesia for exam of colon using an endoscope | 148 | $259,597 | $1,704 | $243 | 6.77x |
| 01967 Anesthesia for labor during planned vaginal delivery | 112 | $593,499 | $6,450 | $1,418 | 2.87x |
| 71046 X-ray of chest, 2 views | 105 | $34,242 | $350 | $71 | 3.34x |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 104 | $200,664 | $1,988 | $282 | 6.87x |
| 01961 Anesthesia for cesarean delivery | 97 | $330,731 | $3,679 | $500 | 6.89x |
| 99472 Follow-up inpatient hospital critical care of infant or young child per day (29 | 97 | $166,200 | $1,880 | $602 | 2.73x |
| 71045 X-ray of chest, 1 view | 91 | $27,669 | $279 | $86 | 2.67x |
| 36415 Insertion of needle into vein for collection of blood sample | 88 | $2,492 | $28 | $11 | 2.02x |
| 00952 Anesthesia for exam of uterus using an endoscope | 87 | $180,745 | $2,264 | $307 | 6.41x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 80 | $10,336 | $120 | $43 | 2.63x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 75 | $218,935 | $2,508 | $117 | 24.74x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 73 | $441,097 | $5,325 | $314 | 15.59x |
| 74177 CT scan of abdomen and pelvis with contrast | 72 | $188,614 | $4,246 | $513 | 4.55x |
| 00790 Anesthesia for other procedure on upper abdomen | 69 | $275,982 | $3,976 | $537 | 6.47x |
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 Michigan?
In 2025 Q1–Q4, the provider or facility offer was selected in 93.0% of 43,925 determined dispute line items for services provided in Michigan. 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 Michigan?
In 2025 Q1–Q4, the median prevailing offer was 3.91x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.42x to 6.81x (n = 25,208 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 Michigan?
In 2025 Q1–Q4, the median was 33 business days (n = 43,925 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Michigan figures count line items whose place of service was Michigan. See methodology for caveats.