Federal IDR outcomes in Montana
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.7% of 611 determined Federal IDR dispute line items for services provided in Montana. The median prevailing offer was 9.07x the QPA (25th–75th percentile 4.12x–20.85x; n = 581). The median time to a decision was 32 business days (n = 611).
Determined line items
611
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
87.7%
n = 611 · 2025 Q1–Q4
Median payment vs QPA
9.07x
middle half 4.12x–20.85x · n = 581 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 611 · 2025 Q1–Q4
Dollar amounts
Total awarded
$35,734
sum of prevailing offers · n = 41 · 2025 Q1–Q4
Total QPA
$9,669
sum of QPAs, same line items · n = 41 · 2025 Q1–Q4
Awarded above QPA
$26,065
total awarded minus total QPA · n = 41 · 2025 Q1–Q4
Median award per line item
$737
mean $872 · n = 41 · 2025 Q1–Q4
Median QPA
$179
per line item · n = 41 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.70x
total awarded ÷ total QPA · n = 41 · 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 | 41 | $35,734 | $9,669 | $26,065 | $737 | $179 | 3.70x |
| 2024 Q3–Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2024 Q3–2025 Q4 | 41 | $35,734 | $9,669 | $26,065 | $737 | $179 | 3.70x |
| 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 | 611 | 87.7% | 9.07x | 4.12x–20.85x | 581 | 32 |
| 2024 Q1–Q4 | 322 | 89.1% | 11.75x | 5.28x–22.35x | 305 | 57 |
| 2023 Q1–Q4 | 41 | 68.3% | 6.34x | 3.70x–11.82x | 34 | 73 |
| 2023 Q1–2025 Q4 | 974 | 87.4% | 9.91x | 4.43x–20.74x | 920 | 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 Montana
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Intraoperative neuromonitoring | 398 | 88.9% | 13.52x | 368 | 28 |
| Internal and family medicine | 150 | 84.0% | 4.46x | 150 | 44 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Montana
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 119 | 89.1% | 8.52x | 113 | 30 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 97 | 81.4% | 26.00x † | 90 | 28 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 64 | 93.8% | 14.76x | 58 | 32 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 62 | 79.0% | 3.88x | 62 | 43.5 |
| 99239 Hospital discharge day management, more than 30 minutes | 57 | 87.7% | 4.12x | 57 | 54 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 39 | 92.3% | 26.04x † | 34 | 25 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 30 | 83.3% | 5.14x | 30 | 31.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Montana
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 |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MONTANA (bcbsmt.com) | 101 | 93.1% | 14.66x | 97 | 23 |
| BCBSTX (bcbstx.com) | 90 | 92.2% | 13.06x | 86 | 26 |
| CIGNA (cigna.com) | 90 | 88.9% | 4.12x | 90 | 34 |
| AETNA (aetna.com) | 63 | 82.5% | 6.28x | 63 | 54 |
| CIGNA (multiplan.com) | 62 | 71.0% | 3.88x | 55 | 79 |
| UNITED HEALTHCARE (uhc.com) | 38 | 81.6% | 12.42x | 32 | 33 |
| FLORIDA BLUE (bcbsfl.com) | 31 | 96.8% | 13.25x | 31 | 49 |
| BCBS OF MICHIGAN (bcbsm.com) | 31 | 100.0% | 110.08x † | 31 | 25 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for services provided in Montana?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.7% of 611 determined dispute line items for services provided in Montana. 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 Montana?
In 2025 Q1–Q4, the median prevailing offer was 9.07x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 4.12x to 20.85x (n = 581 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 Montana?
In 2025 Q1–Q4, the median was 32 business days (n = 611 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Montana figures count line items whose place of service was Montana. See methodology for caveats.