Federal IDR outcomes: Hospitals and facilities in Pennsylvania
In 2025 Q1–Q4, the provider or facility offer prevailed in 94.3% of 21,362 determined Federal IDR dispute line items for hospitals and facilities in Pennsylvania. The median prevailing offer was 3.20x the QPA (25th–75th percentile 1.64x–4.67x; n = 5,840). The median time to a decision was 35 business days (n = 21,362).
Determined line items
21,362
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
94.3%
n = 21,362 · 2025 Q1–Q4
Median payment vs QPA
3.20x
middle half 1.64x–4.67x · n = 5,840 · 2025 Q1–Q4
Median days to decision
35
business days, from dispute initiation · n = 21,362 · 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 | 21,362 | 94.3% | 3.20x | 1.64x–4.67x | 5,840 | 35 |
| 2024 Q1–Q4 | 5,617 | 94.8% | 2.82x | 1.27x–4.86x | 2,008 | 29 |
| 2023 Q1–Q4 | 237 | 65.8% | 2.00x | 1.04x–3.18x | 232 | 80 |
| 2023 Q1–2025 Q4 | 27,216 | 94.2% | 3.08x | 1.54x–4.69x | 8,080 | 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 |
|---|---|---|---|---|---|
| 36415 Insertion of needle into vein for collection of blood sample | 1,108 | 94.9% | 3.79x | 162 | 35 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 931 | 94.3% | 3.78x | 199 | 35 |
| 99285 Emergency department visit with high level of medical decision making | 798 | 94.4% | 2.73x | 739 | 35 |
| 80053 Blood test, comprehensive group of blood chemicals | 617 | 96.6% | 3.72x | 119 | 35 |
| 99284 Emergency department visit with moderate level of medical decision making | 573 | 94.4% | 2.10x | 519 | 35 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 519 | 95.4% | 3.24x | 98 | 35 |
| 84484 Troponin (protein) analysis, quantitative | 501 | 94.2% | 3.79x | 98 | 35 |
| 96374 Injection of drug or substance into vein | 501 | 93.4% | 2.48x | 132 | 35 |
| 80048 Blood test, basic group of blood chemicals (Calcium, total) | 491 | 91.0% | 4.12x | 92 | 31 |
| 83690 Lipase (fat enzyme) level | 446 | 93.9% | 3.76x | 89 | 35 |
| 81025 Urine pregnancy test | 425 | 94.8% | 3.99x | 76 | 34 |
| 96361 Infusion into a vein for hydration, each additional hour | 382 | 94.0% | 4.18x | 115 | 35 |
| 81003 Automated urinalysis test | 337 | 94.4% | 3.52x | 61 | 35 |
| 96375 Injection of additional new drug or substance into vein | 330 | 93.6% | 4.04x | 90 | 35 |
| 81001 Manual urinalysis test with examination using microscope, automated | 329 | 94.2% | 4.47x | 54 | 35 |
| 71045 X-ray of chest, 1 view | 285 | 96.8% | 3.17x | 93 | 35 |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 268 | 95.9% | 3.26x | 49 | 34 |
| 87086 Bacterial colony count, urine | 251 | 94.4% | 4.41x | 55 | 35 |
| 80307 Testing for presence of drug, by chemistry analyzers | 241 | 95.4% | 4.03x | 43 | 35 |
| 87426 Detection test by immunoassay technique for severe acute respiratory syndrome co | 219 | 95.4% | 1.19x | 82 | 34 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Pennsylvania · Hospitals and facilities in all states
FAQ
What is the Federal IDR provider win rate for hospitals and facilities in Pennsylvania?
In 2025 Q1–Q4, the provider or facility offer was selected in 94.3% of 21,362 determined dispute line items for hospitals and facilities in Pennsylvania. 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 hospitals and facilities in Pennsylvania?
In 2025 Q1–Q4, the median prevailing offer was 3.20x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.64x to 4.67x (n = 5,840 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 hospitals and facilities in Pennsylvania?
In 2025 Q1–Q4, the median was 35 business days (n = 21,362 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).