Federal IDR outcomes: Pain medicine in New Jersey
In 2025 Q1–Q4, the provider or facility offer prevailed in 86.3% of 16,115 determined Federal IDR dispute line items for pain medicine in New Jersey. The median prevailing offer was 53.93x the QPA (25th–75th percentile 18.91x–100.42x; n = 8,316). The median time to a decision was 35 business days (n = 16,115).
Determined line items
16,115
2025 Q1–Q4 · 12 split decisions excluded
Provider win rate
86.3%
n = 16,115 · 2025 Q1–Q4
Median days to decision
35
business days, from dispute initiation · n = 16,115 · 2025 Q1–Q4
Dollar amounts are not shown for specialty groups: the CMS QPA and Offers file, the only source of dollar figures, has no specialty field. See methodology.
By period
| Period | Line items | Win % | Median ×QPA | 25th–75th | Ratio n | Median days |
|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | 16,115 | 86.3% | 53.93x † | 18.91x–100.42x | 8,316 | 35 |
| 2024 Q1–Q4 | 6,368 | 79.8% | 31.15x † | 6.80x–62.00x | 3,855 | 77 |
| 2023 Q1–Q4 | 215 | 92.6% | 28.97x † | 12.10x–52.96x | 213 | 24 |
| 2023 Q1–2025 Q4 | 22,698 | 84.6% | 45.36x † | 13.93x–86.28x | 12,384 | 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.
Most disputed CPT codes
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 36475 Destruction of first incompetent vein of arm or leg using radiofrequency and ima | 1,377 | 85.3% | 57.58x † | 518 | 30 |
| 64636 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, | 1,329 | 86.9% | 75.34x † | 635 | 36 |
| 64484 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 1,284 | 85.1% | 71.31x † | 675 | 37 |
| 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 1,229 | 85.9% | 38.10x † | 683 | 36 |
| 64494 Injection of lower or sacral spine facet joint using imaging guidance, second le | 1,072 | 84.3% | 89.00x † | 607 | 36 |
| 20610 Aspiration and/or injection of fluid from large joint | 1,062 | 85.7% | 62.42x † | 470 | 33 |
| 64493 Injection of lower or sacral spine facet joint using imaging guidance, single le | 1,056 | 85.7% | 56.80x † | 588 | 36 |
| 64635 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, | 886 | 86.9% | 27.79x † | 451 | 36.5 |
| 64495 Injection of lower or sacral spine facet joint using imaging guidance, third and | 684 | 84.8% | 80.03x † | 342 | 36 |
| 64634 Destruction of upper or middle spinal facet joint nerves using imaging guidance, | 678 | 89.8% | 59.00x † | 355 | 36 |
| 64491 Injection of upper or middle spine facet joint using imaging guidance, second le | 655 | 88.5% | 82.75x † | 415 | 36 |
| 36465 Injection of chemical agent into single incompetent vein of leg using ultrasound | 643 | 86.5% | 158.40x † | 245 | 30 |
| 64490 Injection of upper or middle spine facet joint using imaging guidance, single le | 642 | 88.0% | 51.94x † | 406 | 35.5 |
| 62321 Injection of substance into middle or upper spine canal using imaging guidance | 528 | 86.4% | 39.55x † | 324 | 32 |
| 64492 Injection of upper or middle spine facet joint using imaging guidance, third and | 458 | 89.3% | 73.82x † | 281 | 36.5 |
| 64633 Destruction of upper or middle spinal facet joint nerves using imaging guidance, | 423 | 88.9% | 24.71x † | 229 | 36 |
| 27096 Injection of anesthetic or steroid into joint between lower spine and hip bone u | 254 | 85.0% | 33.35x † | 142 | 31 |
| 62323 Injection of substance into lower spine canal using imaging guidance | 245 | 88.2% | 35.08x † | 180 | 36 |
| 77003 Fluoroscopic guidance for spine or back muscle injection | 143 | 84.6% | 15.63x | 37 | 196 |
| 20605 Aspiration and/or injection of fluid from medium joint | 140 | 87.9% | 100.78x † | 66 | 25.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in New Jersey · Pain medicine in all states
FAQ
What is the Federal IDR provider win rate for pain medicine in New Jersey?
In 2025 Q1–Q4, the provider or facility offer was selected in 86.3% of 16,115 determined dispute line items for pain medicine in New Jersey. 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 pain medicine in New Jersey?
In 2025 Q1–Q4, the median prevailing offer was 53.93x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 18.91x to 100.42x (n = 8,316 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 pain medicine in New Jersey?
In 2025 Q1–Q4, the median was 35 business days (n = 16,115 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).