Federal IDR outcomes in Nebraska
In 2025 Q1–Q4, the provider or facility offer prevailed in 80.8% of 2,184 determined Federal IDR dispute line items for services provided in Nebraska. The median prevailing offer was 3.78x the QPA (25th–75th percentile 1.78x–5.54x; n = 1,386). The median time to a decision was 32.5 business days (n = 2,184).
Determined line items
2,184
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
80.8%
n = 2,184 · 2025 Q1–Q4
Median payment vs QPA
3.78x
middle half 1.78x–5.54x · n = 1,386 · 2025 Q1–Q4
Median days to decision
32.5
business days, from dispute initiation · n = 2,184 · 2025 Q1–Q4
Dollar amounts
Total awarded
$757,167
sum of prevailing offers · n = 829 · 2025 Q1–Q4
Total QPA
$237,821
sum of QPAs, same line items · n = 829 · 2025 Q1–Q4
Awarded above QPA
$519,346
total awarded minus total QPA · n = 829 · 2025 Q1–Q4
Median award per line item
$783
mean $913 · n = 829 · 2025 Q1–Q4
Median QPA
$195
per line item · n = 829 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.18x
total awarded ÷ total QPA · n = 829 · 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 | 829 | $757,167 | $237,821 | $519,346 | $783 | $195 | 3.18x |
| 2024 Q3–Q4 | 252 | $215,012 | $73,405 | $141,607 | $783 | $266 | 2.93x |
| 2024 Q3–2025 Q4 | 1,081 | $972,180 | $311,227 | $660,953 | $783 | $221 | 3.12x |
| 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 | 2,184 | 80.8% | 3.78x | 1.78x–5.54x | 1,386 | 32.5 |
| 2024 Q1–Q4 | 291 | 67.4% | 3.34x | 1.00x–6.44x | 185 | 74 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 2,489 | 79.3% | 3.75x | 1.60x–5.68x | 1,579 | 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 Nebraska
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 1,282 | 80.6% | 2.69x | 783 | 34 |
| Intraoperative neuromonitoring | 388 | 92.5% | 12.74x | 230 | 33 |
| Anesthesiology | 330 | 81.5% | 3.94x | 330 | 27 |
| Not reported / unspecified | 179 | 54.7% | 1.08x | 38 | 30 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Nebraska
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 82 | 78.0% | 3.30x | 38 | 37 |
| 80053 Blood test, comprehensive group of blood chemicals | 79 | 79.7% | 3.13x | 38 | 35 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 76 | 92.1% | 45.81x † | 46 | 33 |
| 99284 Emergency department visit with moderate level of medical decision making | 75 | 82.7% | 2.03x | 51 | 32 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 56 | 91.1% | 9.41x | 36 | 34 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 56 | 94.6% | 3.99x | 30 | 32 |
| 00812 Anesthesia for exam of colon using an endoscope | 50 | 86.0% | 4.19x | 50 | 26 |
| 84484 Troponin (protein) analysis, quantitative | 50 | 74.0% | – | 21 | 37 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 48 | 95.8% | 22.29x † | 30 | 34 |
| 96374 Injection of drug or substance into vein | 47 | 78.7% | – | 25 | 31 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 42 | 78.6% | – | 20 | 43.5 |
| 99285 Emergency department visit with high level of medical decision making | 40 | 77.5% | 3.42x | 34 | 34.5 |
| 00840 Anesthesia for other procedure on lower abdomen | 38 | 81.6% | 3.89x | 38 | 31.5 |
| 83690 Lipase (fat enzyme) level | 36 | 83.3% | – | 17 | 42.5 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 35 | 94.3% | – | 17 | 32 |
| 96375 Injection of additional new drug or substance into vein | 33 | 87.9% | – | 18 | 33 |
| 95870 Needle measurement of electrical activity in arm, leg, trunk or head muscles, li | 30 | 93.3% | – | 19 | 29 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Nebraska
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 NEBRASKA (nebraskablue.com) | 438 | 73.5% | 2.54x | 278 | 34 |
| UNITED HEALTHCARE (uhc.com) | 332 | 76.5% | 3.92x | 266 | 31.5 |
| AETNA (aetna.com) | 295 | 69.8% | 3.86x | 161 | 24 |
| UMR (clearhs.com) | 199 | 84.4% | 2.69x | 190 | 29 |
| ALLIED BENEFIT SYSTEMS (alliedbenefit.com) | 118 | 99.2% | 3.93x | 56 | 30 |
| ALLIED NATIONAL (alliednational.com) | 75 | 100.0% | – | 0 | 71 |
| CIGNA (cigna.com) | 67 | 86.6% | 2.95x | 67 | 31 |
| BCBSTX (bcbstx.com) | 61 | 100.0% | – | 11 | 33 |
| AMBETTER (centene.com) | 60 | 100.0% | – | 29 | 46 |
| 90 DEGREE BENEFITS (phiagroup.com) | 59 | 22.0% | – | 13 | 32 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Nebraska
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 380 | $305,716 | $783 | $189 | 2.94x |
| 99285 Emergency department visit with high level of medical decision making | 193 | $180,621 | $1,077 | $375 | 2.73x |
| 99291 Critical care, first 30-74 minutes | 68 | $87,092 | $1,393 | $352 | 3.46x |
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 Nebraska?
In 2025 Q1–Q4, the provider or facility offer was selected in 80.8% of 2,184 determined dispute line items for services provided in Nebraska. 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 Nebraska?
In 2025 Q1–Q4, the median prevailing offer was 3.78x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.78x to 5.54x (n = 1,386 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 Nebraska?
In 2025 Q1–Q4, the median was 32.5 business days (n = 2,184 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Nebraska figures count line items whose place of service was Nebraska. See methodology for caveats.