Federal IDR outcomes in New York
In 2025 Q1–Q4, the provider or facility offer prevailed in 86.5% of 172,628 determined Federal IDR dispute line items for services provided in New York. The median prevailing offer was 5.38x the QPA (25th–75th percentile 2.48x–13.01x; n = 157,282). The median time to a decision was 44 business days (n = 172,628).
Determined line items
172,628
2025 Q1–Q4 · 185 split decisions excluded
Provider win rate
86.5%
n = 172,628 · 2025 Q1–Q4
Median payment vs QPA
5.38x
middle half 2.48x–13.01x · n = 157,282 · 2025 Q1–Q4
Median days to decision
44
business days, from dispute initiation · n = 172,628 · 2025 Q1–Q4
Dollar amounts
Total awarded
$2.22B
sum of prevailing offers · n = 217,126 · 2025 Q1–Q4
Total QPA
$171.3M
sum of QPAs, same line items · n = 217,126 · 2025 Q1–Q4
Awarded above QPA
$2.05B
total awarded minus total QPA · n = 217,126 · 2025 Q1–Q4
Median award per line item
$1,001
mean $10,209 · n = 217,126 · 2025 Q1–Q4
Median QPA
$199
per line item · n = 217,126 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
12.94x
total awarded ÷ total QPA · n = 217,126 · 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 | 217,126 | $2.22B | $171.3M | $2.05B | $1,001 | $199 | 12.94x |
| 2024 Q3–Q4 | 70,787 | $551.6M | $50.9M | $500.7M | $853 | $203 | 10.85x |
| 2024 Q3–2025 Q4 | 287,913 | $2.77B | $222.2M | $2.55B | $956 | $201 | 12.46x |
| 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 | 172,628 | 86.5% | 5.38x | 2.48x–13.01x | 157,282 | 44 |
| 2024 Q1–Q4 | 75,849 | 83.9% | 4.36x | 2.22x–9.06x | 68,841 | 99 |
| 2023 Q1–Q4 | 12,230 | 76.5% | 3.67x | 1.54x–7.50x | 11,122 | 78 |
| 2023 Q1–2025 Q4 | 260,707 | 85.3% | 4.89x | 2.36x–10.71x | 237,245 | 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 York
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Radiology | 61,363 | 91.1% | 5.27x | 61,301 | 78 |
| Emergency medicine and emergency departments | 34,765 | 88.2% | 2.52x | 27,152 | 46 |
| Plastic and reconstructive surgery | 13,107 | 87.5% | 24.74x † | 12,247 | 31 |
| Anesthesiology | 8,961 | 78.0% | 5.52x | 8,790 | 34 |
| Intraoperative neuromonitoring | 8,556 | 85.1% | 27.76x † | 6,106 | 43 |
| Neurosurgery and spine surgery | 6,547 | 87.6% | 33.44x † | 5,899 | 35 |
| Orthopedic surgery | 6,256 | 88.3% | 34.39x † | 4,972 | 34 |
| General and other surgery | 5,410 | 86.2% | 20.68x † | 4,936 | 32 |
| Obstetrics and gynecology | 4,688 | 90.4% | 30.65x † | 4,346 | 30 |
| Other / unclassified labels | 4,388 | 81.2% | 10.00x | 3,865 | 35 |
| Not reported / unspecified | 2,513 | 17.1% | 1.00x | 2,076 | 79 |
| Neurology | 2,504 | 84.9% | 27.10x † | 2,276 | 37 |
| Internal and family medicine | 2,472 | 82.3% | 10.23x | 2,469 | 32 |
| Vascular surgery | 2,049 | 78.6% | 34.63x † | 2,016 | 31 |
| Pain medicine | 1,751 | 79.7% | 12.92x | 1,691 | 28 |
| Hospital medicine (hospitalists) | 1,582 | 80.7% | 1.75x | 1,579 | 35 |
| Gastroenterology | 1,230 | 78.9% | 11.94x | 1,212 | 31.5 |
| Cardiology | 1,076 | 75.8% | 5.40x | 1,070 | 53 |
| Cardiothoracic and thoracic surgery | 833 | 74.2% | 39.45x † | 813 | 33 |
| Physical medicine and rehabilitation | 433 | 70.9% | 27.86x † | 432 | 33 |
| Hospitals and facilities | 402 | 53.5% | 1.00x | 339 | 32 |
| Podiatry | 400 | 85.8% | 46.11x † | 390 | 29 |
| Critical care | 363 | 94.2% | 21.97x † | 362 | 28 |
| Infectious disease | 320 | 73.4% | 12.03x | 317 | 25 |
| Surgical assistant services | 287 | 84.0% | 34.77x † | 257 | 32 |
| Laboratory and pathology | 188 | 77.1% | 9.06x | 188 | 23 |
| Neonatology | 157 | 89.2% | 2.63x | 157 | 30 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in New York
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 16,716 | 88.7% | 2.52x | 13,068 | 45 |
| 99285 Emergency department visit with high level of medical decision making | 12,219 | 87.8% | 2.31x | 10,386 | 42 |
| 71045 X-ray of chest, 1 view | 8,834 | 91.7% | 9.06x | 8,814 | 102 |
| 74177 CT scan of abdomen and pelvis with contrast | 4,274 | 90.2% | 5.35x | 4,260 | 56 |
| 99283 Emergency department visit with low level of medical decision making | 3,928 | 88.7% | 3.17x | 3,138 | 44 |
| 71046 X-ray of chest, 2 views | 3,865 | 90.7% | 8.93x | 3,857 | 81 |
| 70450 CT scan head or brain without contrast | 3,537 | 92.0% | 4.73x | 3,527 | 68 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 3,456 | 76.6% | 4.57x | 3,419 | 35 |
| 76641 Complete ultrasound scan of 1 breast | 3,437 | 86.5% | 5.61x | 3,434 | 84 |
| 77067 Screening mammography | 3,172 | 87.5% | 3.45x | 3,163 | 103 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 2,869 | 77.5% | 13.77x | 2,810 | 29 |
| 77063 Screening 3D breast mammography | 2,828 | 91.3% | 2.39x | 2,821 | 84 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 2,673 | 83.7% | 84.92x † | 2,027 | 43 |
| 99291 Critical care, first 30-74 minutes | 2,179 | 85.2% | 3.20x | 1,790 | 36 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 2,002 | 77.7% | 3.76x | 1,390 | 54 |
| 00142 Anesthesia for lens surgery | 1,794 | 73.7% | 11.03x | 1,775 | 30.5 |
| 19318 Breast reduction | 1,737 | 83.9% | 44.34x † | 1,678 | 34 |
| 74176 CT scan of abdomen and pelvis without contrast | 1,720 | 87.4% | 5.37x | 1,711 | 79 |
| 71275 CT scan of blood vessels of chest with contrast | 1,634 | 91.6% | 5.79x | 1,623 | 59 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 1,280 | 84.2% | 39.04x † | 932 | 45 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 1,192 | 84.9% | 15.78x | 818 | 39.5 |
| 22853 Insertion of cage or mesh device to spine bone and disc space during spine fusio | 1,105 | 86.2% | 72.95x † | 969 | 38 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 1,010 | 83.3% | 24.76x † | 818 | 41 |
| 95937 Testing of nerve-muscle junction | 965 | 83.9% | 32.04x † | 636 | 40 |
| 71250 CT scan of chest without contrast | 841 | 90.7% | 4.68x | 839 | 61 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in New York
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 |
|---|---|---|---|---|---|
| UNITED HEALTHCARE (uhc.com) | 86,329 | 84.6% | 5.55x | 80,939 | 72 |
| AETNA (aetna.com) | 28,880 | 91.7% | 2.86x | 27,964 | 29 |
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 25,375 | 86.8% | 17.12x | 20,413 | 35 |
| CIGNA (multiplan.com) | 8,945 | 83.1% | 4.33x | 7,985 | 42 |
| UMR (clearhs.com) | 6,427 | 91.3% | 5.40x | 5,790 | 37 |
| EMBLEM HEALTH (emblemhealth.com) | 3,730 | 93.1% | 22.21x † | 2,859 | 34 |
| UMR (clearhealthcloud.com) | 3,262 | 84.4% | 2.60x | 3,098 | 33 |
| REDACTEDSEIU NATIONAL BENEFIT FUND (1199funds.org) | 2,124 | 67.5% | 23.00x † | 1,937 | 34 |
| CIGNA (cigna.com) | 1,013 | 88.9% | 4.22x | 902 | 37 |
| EXCELLUS BLUECROSS BLUESHIELD (excellus.com) | 834 | 100.0% | 2.09x | 807 | 84 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in New York
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 22,331 | $17.3M | $667 | $289 | 2.71x |
| 99285 Emergency department visit with high level of medical decision making | 11,880 | $12.4M | $893 | $351 | 2.81x |
| 71045 X-ray of chest, 1 view | 7,707 | $612,644 | $99 | $11 | 6.85x |
| 99283 Emergency department visit with low level of medical decision making | 5,846 | $5.3M | $443 | $147 | 5.67x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 4,670 | $9.7M | $1,400 | $84 | 17.32x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 4,252 | $25.6M | $7,353 | $73 | 19.86x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 4,064 | $6.6M | $715 | $114 | 4.79x |
| 74177 CT scan of abdomen and pelvis with contrast | 3,965 | $2.8M | $869 | $162 | 4.42x |
| 71046 X-ray of chest, 2 views | 3,529 | $325,769 | $116 | $12 | 6.72x |
| 70450 CT scan head or brain without contrast | 3,264 | $1.0M | $360 | $75 | 4.03x |
| 76641 Complete ultrasound scan of 1 breast | 3,215 | $828,493 | $298 | $49 | 5.99x |
| 77067 Screening mammography | 2,814 | $446,713 | $171 | $52 | 3.17x |
| 99291 Critical care, first 30-74 minutes | 2,628 | $6.7M | $1,141 | $303 | 5.77x |
| 77063 Screening 3D breast mammography | 2,577 | $297,635 | $121 | $51 | 2.40x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 2,401 | $23.2M | $6,430 | $412 | 9.84x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 2,362 | $21.2M | $10,153 | $179 | 17.52x |
| 22853 Insertion of cage or mesh device to spine bone and disc space during spine fusio | 2,039 | $67.9M | $34,000 | $274 | 17.70x |
| 19318 Breast reduction | 2,001 | $148.9M | $72,000 | $1,255 | 33.39x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 1,960 | $7.1M | $3,381 | $102 | 14.88x |
| 00142 Anesthesia for lens surgery | 1,888 | $8.6M | $5,762 | $430 | 7.98x |
| 74176 CT scan of abdomen and pelvis without contrast | 1,638 | $1.2M | $831 | $163 | 4.51x |
| 71275 CT scan of blood vessels of chest with contrast | 1,495 | $1.1M | $855 | $163 | 4.65x |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 1,442 | $3.6M | $1,400 | $200 | 8.61x |
| 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 1,261 | $16.0M | $11,723 | $236 | 26.59x |
| 47562 Removal of gallbladder using an endoscope | 1,242 | $29.3M | $23,375 | $720 | 26.02x |
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 York?
In 2025 Q1–Q4, the provider or facility offer was selected in 86.5% of 172,628 determined dispute line items for services provided in New York. 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 York?
In 2025 Q1–Q4, the median prevailing offer was 5.38x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.48x to 13.01x (n = 157,282 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 York?
In 2025 Q1–Q4, the median was 44 business days (n = 172,628 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
New York figures count line items whose place of service was New York. See methodology for caveats.