Federal IDR outcomes: Pain medicine in New York
In 2025 Q1–Q4, the provider or facility offer prevailed in 79.7% of 1,751 determined Federal IDR dispute line items for pain medicine in New York. The median prevailing offer was 12.92x the QPA (25th–75th percentile 4.66x–36.38x; n = 1,691). The median time to a decision was 28 business days (n = 1,751).
Determined line items
1,751
2025 Q1–Q4 · 8 split decisions excluded
Provider win rate
79.7%
n = 1,751 · 2025 Q1–Q4
Median payment vs QPA
12.92x
middle half 4.66x–36.38x · n = 1,691 · 2025 Q1–Q4
Median days to decision
28
business days, from dispute initiation · n = 1,751 · 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 | 1,751 | 79.7% | 12.92x | 4.66x–36.38x | 1,691 | 28 |
| 2024 Q1–Q4 | 37 | 78.4% | 16.32x | 2.67x–49.47x | 35 | 42 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 1,792 | 79.6% | 12.92x | 4.60x–36.38x | 1,730 | 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 |
|---|---|---|---|---|---|
| 01992 Anesthesia for nerve block and injection procedure, prone position | 253 | 83.8% | 9.33x | 241 | 26 |
| 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 163 | 82.2% | 20.33x † | 161 | 29 |
| 64484 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 140 | 75.7% | 21.14x † | 139 | 29 |
| 64493 Injection of lower or sacral spine facet joint using imaging guidance, single le | 97 | 73.2% | 21.85x † | 95 | 29 |
| 64494 Injection of lower or sacral spine facet joint using imaging guidance, second le | 89 | 78.7% | 30.08x † | 86 | 30 |
| 62321 Injection of substance into middle or upper spine canal using imaging guidance | 86 | 88.4% | 12.68x | 85 | 30.5 |
| 64490 Injection of upper or middle spine facet joint using imaging guidance, single le | 82 | 78.0% | 18.67x | 80 | 29 |
| 64491 Injection of upper or middle spine facet joint using imaging guidance, second le | 70 | 74.3% | 23.58x † | 68 | 30.5 |
| 62323 Injection of substance into lower spine canal using imaging guidance | 66 | 87.9% | 28.65x † | 64 | 25 |
| 64634 Destruction of upper or middle spinal facet joint nerves using imaging guidance, | 64 | 75.0% | 11.52x | 62 | 33 |
| 64636 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, | 55 | 85.5% | 20.91x † | 55 | 27 |
| 64635 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, | 51 | 78.4% | 12.62x | 51 | 27 |
| 64495 Injection of lower or sacral spine facet joint using imaging guidance, third and | 48 | 79.2% | 32.54x † | 47 | 33 |
| 64633 Destruction of upper or middle spinal facet joint nerves using imaging guidance, | 46 | 78.3% | 10.22x | 43 | 32.5 |
| 64492 Injection of upper or middle spine facet joint using imaging guidance, third and | 44 | 70.5% | 18.47x | 44 | 28.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in New York · Pain medicine in all states
FAQ
What is the Federal IDR provider win rate for pain medicine in New York?
In 2025 Q1–Q4, the provider or facility offer was selected in 79.7% of 1,751 determined dispute line items for pain medicine 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 pain medicine in New York?
In 2025 Q1–Q4, the median prevailing offer was 12.92x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 4.66x to 36.38x (n = 1,691 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 York?
In 2025 Q1–Q4, the median was 28 business days (n = 1,751 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).