Federal IDR outcomes in New Mexico
In 2025 Q1–Q4, the provider or facility offer prevailed in 93.8% of 61,351 determined Federal IDR dispute line items for services provided in New Mexico. The median prevailing offer was 5.21x the QPA (25th–75th percentile 3.81x–8.79x; n = 59,498). The median time to a decision was 32 business days (n = 61,351).
Determined line items
61,351
2025 Q1–Q4 · 96 split decisions excluded
Provider win rate
93.8%
n = 61,351 · 2025 Q1–Q4
Median payment vs QPA
5.21x
middle half 3.81x–8.79x · n = 59,498 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 61,351 · 2025 Q1–Q4
Dollar amounts
Total awarded
$64.9M
sum of prevailing offers · n = 40,793 · 2025 Q1–Q4
Total QPA
$13.2M
sum of QPAs, same line items · n = 40,793 · 2025 Q1–Q4
Awarded above QPA
$51.7M
total awarded minus total QPA · n = 40,793 · 2025 Q1–Q4
Median award per line item
$799
mean $1,591 · n = 40,793 · 2025 Q1–Q4
Median QPA
$166
per line item · n = 40,793 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
4.93x
total awarded ÷ total QPA · n = 40,793 · 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 | 40,793 | $64.9M | $13.2M | $51.7M | $799 | $166 | 4.93x |
| 2024 Q3–Q4 | 2,759 | $3.4M | $688,190 | $2.7M | $799 | $173 | 4.94x |
| 2024 Q3–2025 Q4 | 43,552 | $68.3M | $13.9M | $54.4M | $799 | $167 | 4.93x |
| 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 | 61,351 | 93.8% | 5.21x | 3.81x–8.79x | 59,498 | 32 |
| 2024 Q1–Q4 | 5,581 | 91.8% | 4.68x | 3.13x–8.72x | 5,390 | 39 |
| 2023 Q1–Q4 | 582 | 61.5% | 1.73x | 1.14x–3.31x | 578 | 145 |
| 2023 Q1–2025 Q4 | 67,514 | 93.3% | 5.07x | 3.71x–8.69x | 65,466 | 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 New Mexico
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 60,272 | 94.0% | 5.21x | 58,469 | 32 |
| Intraoperative neuromonitoring | 517 | 87.8% | 13.41x | 497 | 32 |
| Internal and family medicine | 216 | 98.1% | 9.67x | 212 | 37 |
| Not reported / unspecified | 149 | 17.4% | 1.00x | 136 | 48 |
| Anesthesiology | 122 | 95.9% | 5.60x | 120 | 26.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in New Mexico
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 15,743 | 95.0% | 5.24x | 15,488 | 31 |
| 99285 Emergency department visit with high level of medical decision making | 9,620 | 95.3% | 4.68x | 9,498 | 35 |
| 99283 Emergency department visit with low level of medical decision making | 6,193 | 92.6% | 5.72x | 6,079 | 30 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 2,292 | 92.8% | 6.34x | 2,214 | 33 |
| 81003 Automated urinalysis test | 1,517 | 92.9% | 6.55x | 1,461 | 32 |
| 80053 Blood test, comprehensive group of blood chemicals | 1,466 | 93.6% | 6.70x | 1,416 | 34 |
| 96374 Injection of drug or substance into vein | 1,008 | 94.0% | 4.73x | 965 | 34 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 958 | 93.6% | 4.05x | 923 | 34 |
| 96361 Infusion into a vein for hydration, each additional hour | 945 | 93.8% | 3.63x | 903 | 33 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 896 | 93.9% | 12.44x | 868 | 28 |
| 96375 Injection of additional new drug or substance into vein | 884 | 93.7% | 3.84x | 840 | 33 |
| 81025 Urine pregnancy test | 828 | 93.2% | 3.90x | 794 | 33 |
| 87428 Detection test by immunoassay technique for severe acute respiratory syndrome co | 826 | 93.2% | 3.67x | 807 | 33 |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 776 | 91.4% | 6.04x | 748 | 32 |
| 71046 X-ray of chest, 2 views | 760 | 93.4% | 6.10x | 732 | 33 |
| 74177 CT scan of abdomen and pelvis with contrast | 661 | 92.6% | 6.77x | 637 | 35 |
| 82977 Glutamyltransferase (liver enzyme) level | 595 | 91.8% | 4.49x | 574 | 32 |
| 82150 Amylase (enzyme) level | 592 | 91.6% | 6.08x | 571 | 32 |
| 84484 Troponin (protein) analysis, quantitative | 575 | 92.9% | 5.76x | 556 | 33 |
| 96372 Injection of drug or substance under skin or into muscle | 547 | 93.1% | 4.98x | 521 | 33 |
| 82553 Creatine kinase (cardiac enzyme) level, MB fraction only | 541 | 92.2% | 5.38x | 522 | 33 |
| 80076 Liver function blood test panel | 540 | 91.5% | 6.02x | 520 | 32.5 |
| 99291 Critical care, first 30-74 minutes | 495 | 96.0% | 3.66x | 475 | 33 |
| 36415 Insertion of needle into vein for collection of blood sample | 475 | 94.9% | 4.42x | 458 | 31 |
| 99282 Emergency department visit with straightforward medical decision making | 445 | 92.1% | 7.00x | 439 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in New Mexico
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 |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF NEW MEXICO (bcbsnm.com) | 40,671 | 97.6% | 5.24x | 38,941 | 32 |
| UMR (clearhealthcloud.com) | 6,379 | 84.7% | 4.54x | 6,330 | 30 |
| UMR (clearhs.com) | 4,943 | 87.5% | 4.49x | 4,937 | 37 |
| UNITED HEALTHCARE (uhc.com) | 2,797 | 83.4% | 2.79x | 2,781 | 37 |
| CIGNA (multiplan.com) | 2,376 | 80.7% | 5.48x | 2,368 | 28 |
| PRESBYTERIAN (phs.org) | 1,263 | 97.7% | 6.04x | 1,251 | 62 |
| AETNA (aetna.com) | 1,218 | 92.7% | 2.79x | 1,217 | 24 |
| BCBSTX (bcbstx.com) | 286 | 92.7% | 13.20x | 275 | 29 |
| CIGNA (cigna.com) | 253 | 87.7% | 6.55x | 253 | 28 |
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 165 | 100.0% | 6.28x | 162 | 120 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in New Mexico
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 11,541 | $18.8M | $990 | $187 | 5.37x |
| 99285 Emergency department visit with high level of medical decision making | 7,232 | $12.7M | $851 | $216 | 3.56x |
| 99283 Emergency department visit with low level of medical decision making | 4,581 | $8.1M | $1,814 | $174 | 4.74x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 1,538 | $490,681 | $309 | $47 | 5.12x |
| 81003 Automated urinalysis test | 1,016 | $188,864 | $194 | $29 | 5.58x |
| 80053 Blood test, comprehensive group of blood chemicals | 973 | $783,742 | $824 | $115 | 6.59x |
| 96374 Injection of drug or substance into vein | 656 | $286,300 | $454 | $96 | 3.97x |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 622 | $374,784 | $604 | $157 | 3.73x |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 614 | $104,083 | $141 | $15 | 11.63x |
| 96361 Infusion into a vein for hydration, each additional hour | 602 | $530,952 | $354 | $122 | 4.35x |
| 96375 Injection of additional new drug or substance into vein | 576 | $306,898 | $308 | $98 | 3.61x |
| 81025 Urine pregnancy test | 557 | $76,151 | $143 | $37 | 3.41x |
| 87428 Detection test by immunoassay technique for severe acute respiratory syndrome co | 548 | $388,298 | $750 | $208 | 3.83x |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 531 | $209,585 | $408 | $65 | 5.19x |
| 71046 X-ray of chest, 2 views | 483 | $535,918 | $1,198 | $159 | 4.97x |
| 74177 CT scan of abdomen and pelvis with contrast | 441 | $4.7M | $11,837 | $1,616 | 6.32x |
| 82977 Glutamyltransferase (liver enzyme) level | 401 | $43,624 | $117 | $29 | 4.14x |
| 82150 Amylase (enzyme) level | 400 | $117,665 | $318 | $47 | 5.40x |
| 84484 Troponin (protein) analysis, quantitative | 371 | $152,093 | $398 | $67 | 4.89x |
| 80076 Liver function blood test panel | 364 | $144,968 | $430 | $68 | 5.48x |
| 82553 Creatine kinase (cardiac enzyme) level, MB fraction only | 355 | $147,611 | $398 | $65 | 4.91x |
| 96372 Injection of drug or substance under skin or into muscle | 344 | $142,439 | $328 | $72 | 4.17x |
| 99291 Critical care, first 30-74 minutes | 333 | $555,589 | $1,000 | $273 | 4.00x |
| 36415 Insertion of needle into vein for collection of blood sample | 319 | $14,647 | $51 | $12 | 4.13x |
| 99282 Emergency department visit with straightforward medical decision making | 319 | $471,752 | $1,581 | $225 | 4.81x |
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 New Mexico?
In 2025 Q1–Q4, the provider or facility offer was selected in 93.8% of 61,351 determined dispute line items for services provided in New Mexico. 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 New Mexico?
In 2025 Q1–Q4, the median prevailing offer was 5.21x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 3.81x to 8.79x (n = 59,498 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 New Mexico?
In 2025 Q1–Q4, the median was 32 business days (n = 61,351 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
New Mexico figures count line items whose place of service was New Mexico. See methodology for caveats.