Federal IDR outcomes in Nevada
In 2025 Q1–Q4, the provider or facility offer prevailed in 91.6% of 82,972 determined Federal IDR dispute line items for services provided in Nevada. The median prevailing offer was 2.73x the QPA (25th–75th percentile 1.95x–4.00x; n = 67,135). The median time to a decision was 40 business days (n = 82,972).
Determined line items
82,972
2025 Q1–Q4 · 31 split decisions excluded
Provider win rate
91.6%
n = 82,972 · 2025 Q1–Q4
Median payment vs QPA
2.73x
middle half 1.95x–4.00x · n = 67,135 · 2025 Q1–Q4
Median days to decision
40
business days, from dispute initiation · n = 82,972 · 2025 Q1–Q4
Dollar amounts
Total awarded
$49.7M
sum of prevailing offers · n = 53,262 · 2025 Q1–Q4
Total QPA
$12.9M
sum of QPAs, same line items · n = 53,262 · 2025 Q1–Q4
Awarded above QPA
$36.8M
total awarded minus total QPA · n = 53,262 · 2025 Q1–Q4
Median award per line item
$573
mean $934 · n = 53,262 · 2025 Q1–Q4
Median QPA
$186
per line item · n = 53,262 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.85x
total awarded ÷ total QPA · n = 53,262 · 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 | 53,262 | $49.7M | $12.9M | $36.8M | $573 | $186 | 3.85x |
| 2024 Q3–Q4 | 18,556 | $11.7M | $4.9M | $6.9M | $518 | $149 | 2.40x |
| 2024 Q3–2025 Q4 | 71,818 | $61.5M | $17.8M | $43.7M | $569 | $174 | 3.46x |
| 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 | 82,972 | 91.6% | 2.73x | 1.95x–4.00x | 67,135 | 40 |
| 2024 Q1–Q4 | 41,605 | 90.4% | 3.56x | 2.37x–4.60x | 36,057 | 100 |
| 2023 Q1–Q4 | 4,400 | 82.7% | 3.09x | 1.50x–3.88x | 3,948 | 66 |
| 2023 Q1–2025 Q4 | 128,977 | 90.9% | 2.98x | 2.11x–4.47x | 107,140 | 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 Nevada
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 53,397 | 90.5% | 2.66x | 43,715 | 37 |
| Radiology | 11,662 | 98.0% | 2.64x | 11,583 | 51 |
| Hospitals and facilities | 10,178 | 97.2% | 2.12x | 4,399 | 42 |
| Intraoperative neuromonitoring | 4,866 | 84.8% | 13.61x | 4,806 | 34 |
| Not reported / unspecified | 823 | 51.6% | 3.44x | 594 | 35 |
| Pain medicine | 541 | 84.1% | 21.12x † | 540 | 28 |
| Anesthesiology | 410 | 83.9% | 20.57x † | 405 | 27 |
| Vascular surgery | 339 | 92.0% | 64.36x † | 339 | 25 |
| Internal and family medicine | 208 | 86.1% | 5.30x | 208 | 28.5 |
| Critical care | 178 | 88.2% | 23.91x † | 178 | 28 |
| General and other surgery | 174 | 93.7% | 57.89x † | 174 | 27 |
| Laboratory and pathology | 92 | 97.8% | 1.00x | 91 | 48 |
| Other / unclassified labels | 43 | 95.3% | 7.17x | 43 | 567 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Nevada
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 22,268 | 91.1% | 2.73x | 17,445 | 40 |
| 99285 Emergency department visit with high level of medical decision making | 21,857 | 90.2% | 2.45x | 18,441 | 37 |
| 99283 Emergency department visit with low level of medical decision making | 5,260 | 89.6% | 2.87x | 4,707 | 36 |
| 99291 Critical care, first 30-74 minutes | 3,250 | 92.9% | 3.27x | 2,995 | 35 |
| 71045 X-ray of chest, 1 view | 2,744 | 97.3% | 2.52x | 2,696 | 51 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 1,257 | 83.9% | 27.91x † | 1,248 | 39 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 939 | 82.9% | 15.43x | 929 | 36 |
| 77067 Screening mammography | 886 | 99.7% | 2.64x | 885 | 50 |
| 77063 Screening 3D breast mammography | 879 | 99.7% | 2.89x | 878 | 50 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 865 | 81.7% | 8.61x | 849 | 35 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 662 | 84.4% | 12.85x | 651 | 33 |
| 71046 X-ray of chest, 2 views | 629 | 96.8% | 2.50x | 615 | 50 |
| 74177 CT scan of abdomen and pelvis with contrast | 600 | 99.0% | 3.39x | 589 | 66 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 565 | 76.8% | 3.05x | 182 | 19 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 549 | 89.8% | 12.54x | 540 | 33 |
| 74018 X-ray of abdomen, 1 view | 531 | 99.4% | 2.46x | 519 | 50 |
| 36415 Insertion of needle into vein for collection of blood sample | 524 | 96.4% | 2.26x | 88 | 41.5 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 491 | 94.9% | 1.97x | 93 | 41 |
| 70450 CT scan head or brain without contrast | 431 | 98.4% | 3.62x | 414 | 125 |
| 71275 CT scan of blood vessels of chest with contrast | 430 | 95.6% | 2.48x | 418 | 46.5 |
| 80053 Blood test, comprehensive group of blood chemicals | 337 | 94.7% | 3.36x | 64 | 42 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 274 | 96.4% | 2.31x | 57 | 41 |
| 76700 Complete ultrasound scan of abdomen | 254 | 99.2% | 2.61x | 249 | 43 |
| 74176 CT scan of abdomen and pelvis without contrast | 248 | 96.8% | 3.39x | 235 | 45.5 |
| 70553 MRI scan of brain before and after contrast | 223 | 97.3% | 2.16x | 220 | 48 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Nevada
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 |
|---|---|---|---|---|---|
| AETNA (aetna.com) | 26,456 | 96.8% | 2.76x | 26,292 | 41 |
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 19,328 | 92.0% | 2.90x | 18,742 | 36 |
| UNITED HEALTHCARE (uhc.com) | 12,008 | 84.8% | 1.97x | 9,683 | 37 |
| PROMINENCE HEALTHFIRST (uhsinc.com) | 6,380 | 100.0% | 2.12x | 2,587 | 42 |
| CIGNA (cigna.com) | 5,951 | 82.8% | 2.77x | 1,918 | 49 |
| CIGNA (multiplan.com) | 3,507 | 84.4% | 1.88x | 1,851 | 66 |
| UMR (clearhs.com) | 3,376 | 79.2% | 2.26x | 2,139 | 35 |
| BCBSTX (bcbstx.com) | 1,332 | 90.2% | 15.82x | 1,270 | 30 |
| UMR (clearhealthcloud.com) | 1,155 | 95.1% | 3.40x | 900 | 45 |
| CIGNA (zelis.com) | 608 | 93.3% | 3.89x | 178 | 42 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Nevada
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99285 Emergency department visit with high level of medical decision making | 17,472 | $14.0M | $773 | $283 | 2.42x |
| 99284 Emergency department visit with moderate level of medical decision making | 16,316 | $9.6M | $558 | $182 | 2.32x |
| 99283 Emergency department visit with low level of medical decision making | 4,467 | $1.7M | $368 | $100 | 3.02x |
| 99291 Critical care, first 30-74 minutes | 2,811 | $2.6M | $919 | $293 | 3.09x |
| 71045 X-ray of chest, 1 view | 1,935 | $77,918 | $36 | $14 | 2.58x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 890 | $1.4M | $2,020 | $70 | 15.87x |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 630 | $741,121 | $1,141 | $76 | 14.46x |
| 77067 Screening mammography | 628 | $91,098 | $148 | $56 | 2.79x |
| 77063 Screening 3D breast mammography | 574 | $65,479 | $115 | $40 | 2.93x |
| 71046 X-ray of chest, 2 views | 461 | $25,875 | $43 | $17 | 2.75x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 450 | $415,286 | $1,049 | $122 | 5.19x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 416 | $840,767 | $2,479 | $185 | 8.36x |
| 74018 X-ray of abdomen, 1 view | 368 | $13,541 | $36 | $15 | 2.60x |
| 74177 CT scan of abdomen and pelvis with contrast | 320 | $135,092 | $350 | $103 | 3.37x |
| 71275 CT scan of blood vessels of chest with contrast | 319 | $114,107 | $350 | $141 | 2.51x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 227 | $663,241 | $1,794 | $212 | 7.62x |
| 70450 CT scan head or brain without contrast | 195 | $56,518 | $165 | $48 | 3.27x |
| 76642 Limited ultrasound scan of 1 breast | 177 | $22,495 | $133 | $45 | 3.08x |
| 00812 Anesthesia for exam of colon using an endoscope | 173 | $1.3M | $7,200 | $350 | 18.11x |
| 70553 MRI scan of brain before and after contrast | 173 | $74,718 | $444 | $204 | 2.33x |
| 74176 CT scan of abdomen and pelvis without contrast | 166 | $81,933 | $336 | $128 | 2.74x |
| 76700 Complete ultrasound scan of abdomen | 159 | $24,494 | $156 | $59 | 2.73x |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 152 | $18,907 | $35 | $11 | 11.70x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 147 | $662,567 | $5,000 | $75 | 55.75x |
| 01992 Anesthesia for nerve block and injection procedure, prone position | 136 | $925,205 | $7,200 | $350 | 19.15x |
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 Nevada?
In 2025 Q1–Q4, the provider or facility offer was selected in 91.6% of 82,972 determined dispute line items for services provided in Nevada. 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 Nevada?
In 2025 Q1–Q4, the median prevailing offer was 2.73x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.95x to 4.00x (n = 67,135 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 Nevada?
In 2025 Q1–Q4, the median was 40 business days (n = 82,972 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Nevada figures count line items whose place of service was Nevada. See methodology for caveats.