Federal IDR outcomes in Mississippi
In 2025 Q1–Q4, the provider or facility offer prevailed in 85.7% of 65,536 determined Federal IDR dispute line items for services provided in Mississippi. The median prevailing offer was 3.44x the QPA (25th–75th percentile 1.60x–4.77x; n = 57,694). The median time to a decision was 39 business days (n = 65,536).
Determined line items
65,536
2025 Q1–Q4 · 62 split decisions excluded
Provider win rate
85.7%
n = 65,536 · 2025 Q1–Q4
Median payment vs QPA
3.44x
middle half 1.60x–4.77x · n = 57,694 · 2025 Q1–Q4
Median days to decision
39
business days, from dispute initiation · n = 65,536 · 2025 Q1–Q4
Dollar amounts
Total awarded
$110.1M
sum of prevailing offers · n = 115,399 · 2025 Q1–Q4
Total QPA
$39.8M
sum of QPAs, same line items · n = 115,399 · 2025 Q1–Q4
Awarded above QPA
$70.3M
total awarded minus total QPA · n = 115,399 · 2025 Q1–Q4
Median award per line item
$408
mean $954 · n = 115,399 · 2025 Q1–Q4
Median QPA
$135
per line item · n = 115,399 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
2.77x
total awarded ÷ total QPA · n = 115,399 · 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 | 115,399 | $110.1M | $39.8M | $70.3M | $408 | $135 | 2.77x |
| 2024 Q3–Q4 | 56,024 | $50.0M | $18.0M | $32.0M | $286 | $125 | 2.78x |
| 2024 Q3–2025 Q4 | 171,423 | $160.0M | $57.8M | $102.3M | $365 | $130 | 2.77x |
| 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 | 65,536 | 85.7% | 3.44x | 1.60x–4.77x | 57,694 | 39 |
| 2024 Q1–Q4 | 32,670 | 84.4% | 2.67x | 1.36x–4.46x | 27,307 | 81 |
| 2023 Q1–Q4 | 1,741 | 74.7% | 2.25x | 1.32x–3.85x | 1,719 | 76 |
| 2023 Q1–2025 Q4 | 99,947 | 85.1% | 3.06x | 1.49x–4.65x | 86,720 | 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 Mississippi
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Hospitals and facilities | 44,611 | 86.8% | 2.73x | 37,979 | 41 |
| Emergency medicine and emergency departments | 17,901 | 86.5% | 3.97x | 17,680 | 34 |
| Not reported / unspecified | 1,592 | 43.2% | 1.25x | 673 | 39 |
| Intraoperative neuromonitoring | 565 | 86.9% | 13.20x | 505 | 30 |
| Hospital medicine (hospitalists) | 303 | 88.1% | 3.25x | 301 | 24 |
| Anesthesiology | 280 | 84.3% | 4.51x | 277 | 31 |
| Other / unclassified labels | 158 | 88.0% | 1.00x | 157 | 61 |
| Obstetrics and gynecology | 86 | 91.9% | 1.00x | 82 | 63.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Mississippi
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 11,963 | 88.0% | 3.97x | 11,798 | 34 |
| 99285 Emergency department visit with high level of medical decision making | 7,959 | 81.0% | 2.59x | 7,837 | 37 |
| 80053 Blood test, comprehensive group of blood chemicals | 3,073 | 84.8% | 9.09x | 2,813 | 39 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 2,783 | 85.1% | 2.84x | 2,551 | 39 |
| 84484 Troponin (protein) analysis, quantitative | 1,854 | 84.6% | 4.21x | 1,718 | 40 |
| 36415 Insertion of needle into vein for collection of blood sample | 1,701 | 88.9% | 1.70x | 255 | 54 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 1,679 | 86.5% | 2.61x | 1,561 | 39 |
| 81001 Manual urinalysis test with examination using microscope, automated | 1,452 | 84.6% | 7.00x | 1,317 | 39 |
| 83735 Magnesium level | 1,273 | 84.4% | 7.07x | 1,170 | 38 |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 1,164 | 84.4% | 1.25x | 1,071 | 41 |
| 71045 X-ray of chest, 1 view | 1,108 | 86.5% | 2.27x | 1,027 | 41 |
| 99283 Emergency department visit with low level of medical decision making | 1,054 | 88.3% | 4.15x | 1,034 | 33 |
| 83690 Lipase (fat enzyme) level | 830 | 85.1% | 5.09x | 762 | 37 |
| 87635 Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronav | 713 | 84.7% | 1.77x | 671 | 41 |
| 96374 Injection of drug or substance into vein | 687 | 88.8% | 2.02x | 120 | 52 |
| 70450 CT scan head or brain without contrast | 679 | 85.3% | 3.55x | 640 | 40 |
| 74177 CT scan of abdomen and pelvis with contrast | 665 | 85.0% | 6.53x | 616 | 41 |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 624 | 86.2% | 3.79x | 571 | 38 |
| 99291 Critical care, first 30-74 minutes | 561 | 89.1% | 2.39x | 554 | 29 |
| 96375 Injection of additional new drug or substance into vein | 551 | 89.3% | 1.02x | 93 | 52 |
| 81025 Urine pregnancy test | 540 | 84.6% | 6.19x | 489 | 40.5 |
| 96361 Infusion into a vein for hydration, each additional hour | 425 | 87.3% | 1.28x | 85 | 48 |
| 87040 Bacterial blood culture | 422 | 86.3% | 8.79x | 378 | 38 |
| 96372 Injection of drug or substance under skin or into muscle | 416 | 90.1% | 1.28x | 50 | 54 |
| 83605 Lactic acid level | 408 | 86.8% | 5.84x | 368 | 39 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Mississippi
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) | 40,174 | 84.2% | 2.84x | 36,107 | 40 |
| UNITED HEALTHCARE (uhc.com) | 10,460 | 86.0% | 4.19x | 7,988 | 34 |
| CIGNA (multiplan.com) | 2,865 | 80.7% | 3.99x | 2,716 | 43 |
| CIGNA (zelis.com) | 2,800 | 97.1% | 3.59x | 2,433 | 42 |
| AMBETTER (centene.com) | 2,568 | 96.1% | 2.33x | 2,472 | 38 |
| UMR (clearhs.com) | 2,564 | 87.6% | 3.74x | 2,501 | 26 |
| UMR (clearhealthcloud.com) | 2,137 | 90.1% | 3.50x | 2,106 | 35 |
| RES-CARE, INC. DBA BRIGHTSPRING HEALTH SERVICES (springtidehealth.com) | 290 | 53.8% | 1.15x | 75 | 130 |
| BCBS OF MISSISSIPPI (bcbsms.com) | 241 | 83.0% | 1.00x | 237 | 66 |
| BCBSTX (bcbstx.com) | 173 | 87.3% | 13.20x | 167 | 26 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Mississippi
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 25,364 | $24.1M | $664 | $174 | 3.30x |
| 99285 Emergency department visit with high level of medical decision making | 17,852 | $28.8M | $1,132 | $266 | 2.51x |
| 80053 Blood test, comprehensive group of blood chemicals | 5,259 | $2.8M | $606 | $65 | 5.96x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 4,808 | $569,972 | $120 | $39 | 3.02x |
| 99283 Emergency department visit with low level of medical decision making | 3,271 | $1.8M | $414 | $141 | 2.33x |
| 84484 Troponin (protein) analysis, quantitative | 3,116 | $668,170 | $225 | $75 | 2.94x |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 3,104 | $876,699 | $293 | $109 | 2.48x |
| 81001 Manual urinalysis test with examination using microscope, automated | 2,312 | $269,969 | $134 | $20 | 4.86x |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 2,104 | $403,678 | $249 | $75 | 2.56x |
| 71045 X-ray of chest, 1 view | 2,033 | $553,551 | $280 | $103 | 2.31x |
| 83735 Magnesium level | 1,864 | $311,598 | $188 | $37 | 4.57x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 1,352 | $373,978 | $278 | $91 | 3.18x |
| 87635 Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronav | 1,338 | $175,242 | $130 | $65 | 1.04x |
| 83690 Lipase (fat enzyme) level | 1,336 | $279,946 | $251 | $47 | 4.36x |
| 74177 CT scan of abdomen and pelvis with contrast | 1,303 | $6.9M | $6,283 | $999 | 5.13x |
| 70450 CT scan head or brain without contrast | 1,227 | $2.3M | $2,122 | $539 | 3.44x |
| 99291 Critical care, first 30-74 minutes | 1,138 | $1.3M | $1,010 | $293 | 3.08x |
| 84703 Gonadotropin (reproductive hormone) analysis | 1,135 | $233,682 | $233 | $43 | 4.52x |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 970 | $109,108 | $103 | $27 | 3.46x |
| 36415 Insertion of needle into vein for collection of blood sample | 951 | $63,066 | $27 | $10 | 1.51x |
| 96374 Injection of drug or substance into vein | 824 | $755,509 | $312 | $311 | 1.25x |
| 81025 Urine pregnancy test | 638 | $144,539 | $250 | $46 | 5.49x |
| 87040 Bacterial blood culture | 532 | $224,386 | $467 | $78 | 4.51x |
| 83605 Lactic acid level | 528 | $154,026 | $341 | $40 | 5.86x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 518 | $235,450 | $385 | $130 | 3.61x |
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 Mississippi?
In 2025 Q1–Q4, the provider or facility offer was selected in 85.7% of 65,536 determined dispute line items for services provided in Mississippi. 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 Mississippi?
In 2025 Q1–Q4, the median prevailing offer was 3.44x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.60x to 4.77x (n = 57,694 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 Mississippi?
In 2025 Q1–Q4, the median was 39 business days (n = 65,536 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Mississippi figures count line items whose place of service was Mississippi. See methodology for caveats.