Federal IDR outcomes in Oregon
In 2025 Q1–Q4, the provider or facility offer prevailed in 56.3% of 6,926 determined Federal IDR dispute line items for services provided in Oregon. The median prevailing offer was 1.76x the QPA (25th–75th percentile 1.00x–4.47x; n = 6,487). The median time to a decision was 43 business days (n = 6,926).
Determined line items
6,926
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
56.3%
n = 6,926 · 2025 Q1–Q4
Median payment vs QPA
1.76x
middle half 1.00x–4.47x · n = 6,487 · 2025 Q1–Q4
Median days to decision
43
business days, from dispute initiation · n = 6,926 · 2025 Q1–Q4
Dollar amounts
Total awarded
$3.5M
sum of prevailing offers · n = 4,472 · 2025 Q1–Q4
Total QPA
$1.2M
sum of QPAs, same line items · n = 4,472 · 2025 Q1–Q4
Awarded above QPA
$2.3M
total awarded minus total QPA · n = 4,472 · 2025 Q1–Q4
Median award per line item
$103
mean $787 · n = 4,472 · 2025 Q1–Q4
Median QPA
$68
per line item · n = 4,472 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
2.99x
total awarded ÷ total QPA · n = 4,472 · 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 | 4,472 | $3.5M | $1.2M | $2.3M | $103 | $68 | 2.99x |
| 2024 Q3–Q4 | 485 | $607,630 | $185,831 | $421,799 | $1,050 | $194 | 3.27x |
| 2024 Q3–2025 Q4 | 4,957 | $4.1M | $1.4M | $2.8M | $134 | $78 | 3.03x |
| 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 | 6,926 | 56.3% | 1.76x | 1.00x–4.47x | 6,487 | 43 |
| 2024 Q1–Q4 | 1,742 | 63.0% | 2.30x | 1.00x–8.26x | 1,615 | 90 |
| 2023 Q1–Q4 | 346 | 36.4% | 1.03x | 1.00x–5.06x | 326 | 103.5 |
| 2023 Q1–2025 Q4 | 9,014 | 56.9% | 1.82x | 1.00x–5.56x | 8,428 | 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 Oregon
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Radiology | 3,159 | 58.1% | 2.10x | 3,159 | 41 |
| Intraoperative neuromonitoring | 1,418 | 82.9% | 10.19x | 1,142 | 28 |
| Not reported / unspecified | 1,144 | 4.0% | 1.00x | 1,005 | 86 |
| Emergency medicine and emergency departments | 774 | 60.3% | 1.52x | 750 | 69.5 |
| Anesthesiology | 172 | 98.3% | 2.20x | 172 | 32 |
| Internal and family medicine | 94 | 74.5% | 2.34x | 94 | 32 |
| Hospitals and facilities | 78 | 88.5% | 2.13x | 78 | 52.5 |
| Hospital medicine (hospitalists) | 36 | 91.7% | 1.06x | 36 | 45 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Oregon
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 71045 X-ray of chest, 1 view | 528 | 43.0% | 1.20x | 527 | 43 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 461 | 81.6% | 17.86x | 400 | 28 |
| 71046 X-ray of chest, 2 views | 318 | 45.9% | 1.00x | 317 | 91 |
| 77067 Screening mammography | 313 | 21.1% | 1.00x | 313 | 74 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 295 | 81.7% | 8.03x | 254 | 30 |
| 77063 Screening 3D breast mammography | 289 | 4.2% | 1.00x | 289 | 229 |
| 70450 CT scan head or brain without contrast | 255 | 52.9% | 1.50x | 253 | 41 |
| 99284 Emergency department visit with moderate level of medical decision making | 254 | 28.3% | 1.00x | 254 | 153 |
| 99285 Emergency department visit with high level of medical decision making | 233 | 45.9% | 1.00x | 229 | 52 |
| 74177 CT scan of abdomen and pelvis with contrast | 193 | 58.0% | 2.13x | 192 | 76 |
| 74018 X-ray of abdomen, 1 view | 134 | 53.7% | 1.93x | 134 | 76 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 127 | 85.8% | 5.56x | 105 | 25 |
| 76642 Limited ultrasound scan of 1 breast | 107 | 43.0% | 1.00x | 107 | 45 |
| 76641 Complete ultrasound scan of 1 breast | 106 | 64.2% | 3.57x | 106 | 41 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 80 | 90.0% | 46.45x † | 41 | 25 |
| 73630 X-ray of foot, minimum of 3 views | 79 | 38.0% | 1.20x | 79 | 44 |
| 73030 X-ray of shoulder, minimum of 2 views | 71 | 42.3% | 1.00x | 71 | 58 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 69 | 82.6% | 13.77x | 35 | 25 |
| 70498 CT scan of blood vessels of neck with contrast | 66 | 45.5% | 1.20x | 66 | 38 |
| 70496 CT scan of blood vessels of head with contrast | 64 | 46.9% | 1.20x | 64 | 38 |
| 71260 CT scan of chest with contrast | 63 | 69.8% | 2.11x | 63 | 43 |
| 72125 CT scan of upper spine without contrast | 63 | 49.2% | 1.20x | 63 | 36 |
| 73610 X-ray of ankle, minimum of 3 views | 58 | 44.8% | 1.20x | 58 | 42.5 |
| 73562 X-ray of knee, 3 views | 56 | 35.7% | 1.20x | 56 | 39 |
| 95937 Testing of nerve-muscle junction | 54 | 88.9% | – | 27 | 25.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Oregon
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 |
|---|---|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (regence.com) | 2,809 | 42.7% | 1.00x | 2,769 | 95 |
| CIGNA (multiplan.com) | 1,865 | 49.3% | 1.20x | 1,857 | 28 |
| UMR (clearhs.com) | 792 | 77.3% | 7.61x | 750 | 33 |
| MODA HEALTH (modahealth.com) | 391 | 92.3% | 3.23x | 325 | 30 |
| UNITED HEALTHCARE (uhc.com) | 229 | 86.5% | 7.75x | 172 | 38 |
| UMR (clearhealthcloud.com) | 190 | 37.4% | 2.02x | 83 | 589 |
| PACIFICSOURCE (pacificsource.com) | 94 | 87.2% | 2.16x | 62 | 27 |
| BCBSTX (bcbstx.com) | 79 | 60.8% | 9.69x | 77 | 36 |
| AETNA (aetna.com) | 73 | 93.2% | 7.27x | 55 | 20 |
| CIGNA (cigna.com) | 50 | 76.0% | 2.16x | 44 | 30 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Oregon
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 71045 X-ray of chest, 1 view | 431 | $11,519 | $27 | $18 | 1.52x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 368 | $600,250 | $1,817 | $82 | 15.31x |
| 77067 Screening mammography | 311 | $25,720 | $77 | $60 | 1.22x |
| 77063 Screening 3D breast mammography | 277 | $15,170 | $48 | $48 | 0.86x |
| 71046 X-ray of chest, 2 views | 272 | $10,824 | $31 | $21 | 1.87x |
| 99284 Emergency department visit with moderate level of medical decision making | 221 | $116,257 | $255 | $255 | 1.40x |
| 99285 Emergency department visit with high level of medical decision making | 220 | $835,237 | $853 | $376 | 1.41x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 217 | $448,442 | $2,229 | $213 | 7.89x |
| 74177 CT scan of abdomen and pelvis with contrast | 187 | $67,434 | $376 | $142 | 2.51x |
| 70450 CT scan head or brain without contrast | 181 | $23,284 | $124 | $82 | 1.74x |
| 74018 X-ray of abdomen, 1 view | 125 | $4,562 | $38 | $14 | 3.16x |
| 76642 Limited ultrasound scan of 1 breast | 106 | $9,611 | $62 | $45 | 1.94x |
| 76641 Complete ultrasound scan of 1 breast | 105 | $12,260 | $152 | $34 | 2.90x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 101 | $487,080 | $3,550 | $527 | 5.32x |
| 73630 X-ray of foot, minimum of 3 views | 75 | $1,781 | $14 | $13 | 1.90x |
| 73030 X-ray of shoulder, minimum of 2 views | 67 | $1,810 | $20 | $15 | 2.11x |
| 73562 X-ray of knee, 3 views | 55 | $1,397 | $22 | $14 | 2.00x |
| 73610 X-ray of ankle, minimum of 3 views | 55 | $1,480 | $20 | $14 | 2.11x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 53 | $53,923 | $915 | $181 | 5.16x |
| 72125 CT scan of upper spine without contrast | 50 | $7,206 | $124 | $98 | 2.20x |
| 73130 X-ray of hand, minimum of 3 views | 44 | $1,054 | $19 | $14 | 1.78x |
| 76856 Complete ultrasound scan of pelvis | 42 | $2,756 | $54 | $54 | 1.35x |
| 70498 CT scan of blood vessels of neck with contrast | 41 | $11,128 | $309 | $161 | 1.64x |
| 70553 MRI scan of brain before and after contrast | 40 | $12,639 | $292 | $190 | 1.48x |
| 71260 CT scan of chest with contrast | 40 | $7,899 | $242 | $90 | 2.16x |
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 Oregon?
In 2025 Q1–Q4, the provider or facility offer was selected in 56.3% of 6,926 determined dispute line items for services provided in Oregon. 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 Oregon?
In 2025 Q1–Q4, the median prevailing offer was 1.76x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.00x to 4.47x (n = 6,487 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 Oregon?
In 2025 Q1–Q4, the median was 43 business days (n = 6,926 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Oregon figures count line items whose place of service was Oregon. See methodology for caveats.