Federal IDR outcomes in Oklahoma
In 2025 Q1–Q4, the provider or facility offer prevailed in 92.4% of 121,005 determined Federal IDR dispute line items for services provided in Oklahoma. The median prevailing offer was 5.23x the QPA (25th–75th percentile 3.01x–14.10x; n = 108,767). The median time to a decision was 32 business days (n = 121,005).
Determined line items
121,005
2025 Q1–Q4 · 56 split decisions excluded
Provider win rate
92.4%
n = 121,005 · 2025 Q1–Q4
Median payment vs QPA
5.23x
middle half 3.01x–14.10x · n = 108,767 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 121,005 · 2025 Q1–Q4
Dollar amounts
Total awarded
$141.5M
sum of prevailing offers · n = 89,245 · 2025 Q1–Q4
Total QPA
$26.6M
sum of QPAs, same line items · n = 89,245 · 2025 Q1–Q4
Awarded above QPA
$115.0M
total awarded minus total QPA · n = 89,245 · 2025 Q1–Q4
Median award per line item
$616
mean $1,586 · n = 89,245 · 2025 Q1–Q4
Median QPA
$160
per line item · n = 89,245 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
5.33x
total awarded ÷ total QPA · n = 89,245 · 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 | 89,245 | $141.5M | $26.6M | $115.0M | $616 | $160 | 5.33x |
| 2024 Q3–Q4 | 12,317 | $19.9M | $3.6M | $16.3M | $642 | $182 | 5.51x |
| 2024 Q3–2025 Q4 | 101,562 | $161.4M | $30.2M | $131.3M | $616 | $167 | 5.35x |
| 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 | 121,005 | 92.4% | 5.23x | 3.01x–14.10x | 108,767 | 32 |
| 2024 Q1–Q4 | 23,351 | 87.9% | 3.25x | 2.52x–6.91x | 20,924 | 62 |
| 2023 Q1–Q4 | 2,059 | 74.7% | 2.79x | 1.86x–4.15x | 1,878 | 80 |
| 2023 Q1–2025 Q4 | 146,415 | 91.4% | 4.77x | 2.85x–13.08x | 131,569 | 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 Oklahoma
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 90,054 | 93.4% | 5.64x | 87,201 | 33 |
| General and other surgery | 8,168 | 98.4% | 2.00x | 7,941 | 32 |
| Hospitals and facilities | 5,888 | 85.2% | 3.69x | 1,910 | 24 |
| Intraoperative neuromonitoring | 5,791 | 91.2% | 71.72x † | 4,798 | 31 |
| Anesthesiology | 5,184 | 91.0% | 10.92x | 4,151 | 31 |
| Not reported / unspecified | 3,567 | 66.7% | 1.00x | 575 | 23 |
| Neonatology | 552 | 94.4% | 3.60x | 552 | 146.5 |
| Hospital medicine (hospitalists) | 485 | 94.4% | 2.93x | 465 | 25 |
| Neurology | 483 | 90.3% | 91.58x † | 464 | 31 |
| Infectious disease | 314 | 82.5% | 4.60x | 313 | 35 |
| Internal and family medicine | 258 | 97.7% | 10.85x | 251 | 30 |
| Laboratory and pathology | 198 | 96.5% | 1.00x | 84 | 35 |
| Other / unclassified labels | 38 | 86.8% | 3.60x | 37 | 34 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Oklahoma
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 27,853 | 91.4% | 4.05x | 27,015 | 33 |
| 99285 Emergency department visit with high level of medical decision making | 12,905 | 90.6% | 3.07x | 11,980 | 38 |
| 99283 Emergency department visit with low level of medical decision making | 10,407 | 92.1% | 4.92x | 9,778 | 30 |
| 81003 Automated urinalysis test | 2,261 | 93.5% | 10.82x | 2,061 | 31 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 1,911 | 92.5% | 6.21x | 1,472 | 37 |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 1,776 | 94.7% | 9.98x | 1,765 | 24 |
| 80053 Blood test, comprehensive group of blood chemicals | 1,661 | 91.4% | 7.60x | 1,256 | 28 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 1,623 | 86.3% | 3.81x | 1,592 | 33 |
| 96374 Injection of drug or substance into vein | 1,571 | 93.6% | 8.38x | 1,134 | 31 |
| 96375 Injection of additional new drug or substance into vein | 1,504 | 94.3% | 7.04x | 1,086 | 31 |
| 96361 Infusion into a vein for hydration, each additional hour | 1,487 | 92.9% | 5.74x | 1,304 | 31 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 1,480 | 93.5% | 11.44x | 1,386 | 32 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 1,397 | 94.1% | 5.24x | 1,182 | 30 |
| 87428 Detection test by immunoassay technique for severe acute respiratory syndrome co | 1,368 | 92.9% | 11.06x | 1,318 | 44 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 1,354 | 91.1% | 138.58x † | 1,150 | 31 |
| 81025 Urine pregnancy test | 1,225 | 92.2% | 6.68x | 1,116 | 31 |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 1,140 | 94.6% | 6.39x | 1,094 | 33.5 |
| 82150 Amylase (enzyme) level | 1,095 | 94.3% | 8.41x | 1,042 | 32 |
| 84484 Troponin (protein) analysis, quantitative | 1,053 | 93.3% | 5.14x | 895 | 31 |
| 74177 CT scan of abdomen and pelvis with contrast | 991 | 94.5% | 6.15x | 916 | 31 |
| 82977 Glutamyltransferase (liver enzyme) level | 990 | 95.6% | 7.85x | 984 | 33 |
| 80076 Liver function blood test panel | 988 | 94.7% | 8.36x | 978 | 33 |
| 71045 X-ray of chest, 1 view | 967 | 94.0% | 4.33x | 833 | 34 |
| 99291 Critical care, first 30-74 minutes | 928 | 87.8% | 3.98x | 884 | 34 |
| 71046 X-ray of chest, 2 views | 927 | 94.2% | 8.14x | 851 | 35 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Oklahoma
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 |
|---|---|---|---|---|---|
| BCBS OF TX (bcbsil.com) | 31,849 | 96.7% | 11.51x | 30,232 | 39 |
| UNITED HEALTHCARE (uhc.com) | 20,334 | 87.2% | 3.21x | 19,161 | 40 |
| BLUECROSS BLUESHIELD OF OKLAHOMA (bcbsok.com) | 19,189 | 97.2% | 12.80x | 16,822 | 22 |
| AMBETTER (centene.com) | 12,097 | 97.3% | 2.01x | 10,366 | 29 |
| UMR (clearhs.com) | 9,640 | 85.5% | 3.92x | 8,982 | 37 |
| CIGNA (multiplan.com) | 6,130 | 79.9% | 4.84x | 4,381 | 28 |
| UMR (clearhealthcloud.com) | 5,573 | 92.4% | 2.85x | 5,426 | 38 |
| BCBSTX (bcbstx.com) | 3,806 | 94.8% | 90.71x † | 3,240 | 29 |
| AETNA (aetna.com) | 3,716 | 90.9% | 4.28x | 3,274 | 26 |
| COMMUNITY CARE (ccok.com) | 2,193 | 98.9% | 12.15x | 2,163 | 39 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Oklahoma
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 24,674 | $36.3M | $622 | $188 | 4.84x |
| 99285 Emergency department visit with high level of medical decision making | 11,599 | $22.8M | $851 | $301 | 3.33x |
| 99283 Emergency department visit with low level of medical decision making | 8,931 | $15.5M | $1,814 | $109 | 4.56x |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 1,979 | $439,421 | $225 | $19 | 7.35x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 1,962 | $987,150 | $616 | $130 | 3.33x |
| 81003 Automated urinalysis test | 1,861 | $342,210 | $194 | $18 | 7.23x |
| 80053 Blood test, comprehensive group of blood chemicals | 1,810 | $1.2M | $824 | $51 | 8.61x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 1,399 | $1.3M | $309 | $25 | 24.75x |
| 96374 Injection of drug or substance into vein | 1,318 | $545,446 | $454 | $196 | 2.69x |
| 96361 Infusion into a vein for hydration, each additional hour | 1,302 | $1.1M | $354 | $80 | 4.88x |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 1,163 | $704,650 | $604 | $113 | 5.03x |
| 96375 Injection of additional new drug or substance into vein | 1,102 | $549,857 | $308 | $80 | 4.49x |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 1,084 | $163,949 | $141 | $13 | 10.90x |
| 81025 Urine pregnancy test | 960 | $125,513 | $143 | $28 | 4.46x |
| 84484 Troponin (protein) analysis, quantitative | 898 | $424,407 | $398 | $66 | 5.99x |
| 71046 X-ray of chest, 2 views | 876 | $946,338 | $1,198 | $126 | 6.48x |
| 74177 CT scan of abdomen and pelvis with contrast | 853 | $8.3M | $11,837 | $994 | 6.83x |
| 82150 Amylase (enzyme) level | 821 | $243,197 | $318 | $42 | 6.92x |
| 99291 Critical care, first 30-74 minutes | 764 | $1.2M | $1,392 | $294 | 3.80x |
| 71045 X-ray of chest, 1 view | 743 | $506,507 | $780 | $115 | 4.93x |
| 82977 Glutamyltransferase (liver enzyme) level | 736 | $80,915 | $117 | $18 | 5.40x |
| 96372 Injection of drug or substance under skin or into muscle | 727 | $299,258 | $328 | $65 | 4.32x |
| 80076 Liver function blood test panel | 704 | $280,579 | $430 | $74 | 5.92x |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 685 | $283,509 | $408 | $79 | 5.31x |
| 87428 Detection test by immunoassay technique for severe acute respiratory syndrome co | 676 | $473,410 | $750 | $49 | 8.14x |
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 Oklahoma?
In 2025 Q1–Q4, the provider or facility offer was selected in 92.4% of 121,005 determined dispute line items for services provided in Oklahoma. 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 Oklahoma?
In 2025 Q1–Q4, the median prevailing offer was 5.23x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 3.01x to 14.10x (n = 108,767 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 Oklahoma?
In 2025 Q1–Q4, the median was 32 business days (n = 121,005 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Oklahoma figures count line items whose place of service was Oklahoma. See methodology for caveats.