Federal IDR outcomes in South Carolina
In 2025 Q1–Q4, the provider or facility offer prevailed in 83.2% of 44,254 determined Federal IDR dispute line items for services provided in South Carolina. The median prevailing offer was 3.12x the QPA (25th–75th percentile 1.73x–5.95x; n = 43,660). The median time to a decision was 40 business days (n = 44,254).
Determined line items
44,254
2025 Q1–Q4 · 48 split decisions excluded
Provider win rate
83.2%
n = 44,254 · 2025 Q1–Q4
Median payment vs QPA
3.12x
middle half 1.73x–5.95x · n = 43,660 · 2025 Q1–Q4
Median days to decision
40
business days, from dispute initiation · n = 44,254 · 2025 Q1–Q4
Dollar amounts
Total awarded
$67.6M
sum of prevailing offers · n = 46,406 · 2025 Q1–Q4
Total QPA
$12.9M
sum of QPAs, same line items · n = 46,406 · 2025 Q1–Q4
Awarded above QPA
$54.7M
total awarded minus total QPA · n = 46,406 · 2025 Q1–Q4
Median award per line item
$614
mean $1,457 · n = 46,406 · 2025 Q1–Q4
Median QPA
$206
per line item · n = 46,406 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
5.25x
total awarded ÷ total QPA · n = 46,406 · 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 | 46,406 | $67.6M | $12.9M | $54.7M | $614 | $206 | 5.25x |
| 2024 Q3–Q4 | 15,684 | $14.5M | $5.2M | $9.3M | $579 | $229 | 2.79x |
| 2024 Q3–2025 Q4 | 62,090 | $82.1M | $18.1M | $64.0M | $608 | $212 | 4.54x |
| 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 | 44,254 | 83.2% | 3.12x | 1.73x–5.95x | 43,660 | 40 |
| 2024 Q1–Q4 | 19,853 | 86.1% | 2.80x | 1.62x–10.01x | 19,612 | 96 |
| 2023 Q1–Q4 | 4,962 | 77.3% | 1.63x | 1.42x–2.55x | 4,809 | 69 |
| 2023 Q1–2025 Q4 | 69,069 | 83.6% | 2.93x | 1.64x–5.98x | 68,081 | 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 South Carolina
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 27,933 | 87.8% | 3.05x | 27,710 | 43 |
| Radiology | 7,321 | 69.5% | 19.64x | 7,317 | 35 |
| Intraoperative neuromonitoring | 2,158 | 86.4% | 15.88x | 1,919 | 36 |
| Hospital medicine (hospitalists) | 1,931 | 94.0% | 1.36x | 1,928 | 28 |
| Neonatology | 1,856 | 84.1% | 2.44x | 1,830 | 39 |
| Anesthesiology | 1,485 | 78.6% | 3.54x | 1,454 | 43 |
| Hospitals and facilities | 788 | 76.8% | 2.41x | 733 | 28 |
| Not reported / unspecified | 530 | 1.7% | 1.00x | 517 | 166 |
| Other / unclassified labels | 92 | 78.3% | 1.58x | 92 | 69 |
| Internal and family medicine | 84 | 81.0% | 5.94x | 84 | 36.5 |
| Neurology | 51 | 90.2% | 45.91x † | 51 | 30 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in South Carolina
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 17,581 | 86.5% | 2.95x | 17,454 | 43 |
| 99285 Emergency department visit with high level of medical decision making | 7,417 | 85.2% | 3.18x | 7,358 | 39 |
| 99283 Emergency department visit with low level of medical decision making | 2,737 | 89.4% | 3.65x | 2,708 | 73 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 984 | 98.2% | 1.35x | 984 | 22 |
| 77063 Screening 3D breast mammography | 807 | 68.2% | 19.63x | 807 | 45 |
| 77067 Screening mammography | 794 | 68.3% | 19.61x | 794 | 34 |
| 99291 Critical care, first 30-74 minutes | 774 | 91.2% | 2.93x | 771 | 33 |
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 619 | 85.9% | 2.44x | 593 | 42 |
| 71045 X-ray of chest, 1 view | 615 | 66.0% | 59.74x † | 611 | 48 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 555 | 87.4% | 24.36x † | 492 | 36 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 446 | 90.4% | 2.65x | 443 | 43 |
| 74177 CT scan of abdomen and pelvis with contrast | 435 | 69.0% | 19.81x | 424 | 38 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 384 | 87.2% | 13.46x | 343 | 37 |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 350 | 72.6% | 2.17x | 350 | 42.5 |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 343 | 79.9% | 2.38x | 343 | 37 |
| 99239 Hospital discharge day management, more than 30 minutes | 325 | 80.0% | 1.35x | 325 | 30 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 313 | 88.5% | 16.94x | 276 | 37 |
| 00812 Anesthesia for exam of colon using an endoscope | 312 | 82.7% | 4.53x | 312 | 36 |
| 71046 X-ray of chest, 2 views | 307 | 70.4% | 49.88x † | 307 | 38 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 276 | 86.2% | 12.20x | 239 | 35 |
| 70450 CT scan head or brain without contrast | 272 | 63.2% | 19.14x | 264 | 35 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 249 | 94.0% | 1.36x | 249 | 30 |
| 71275 CT scan of blood vessels of chest with contrast | 157 | 63.1% | 13.54x | 153 | 35 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 156 | 84.0% | 11.31x | 152 | 50 |
| 77065 Diagnostic mammography of 1 breast | 152 | 65.1% | 14.35x | 152 | 35 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in South Carolina
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) | 25,826 | 85.1% | 3.06x | 25,531 | 44 |
| CIGNA (cigna.com) | 5,896 | 71.6% | 3.86x | 5,877 | 36 |
| AMBETTER (centene.com) | 5,240 | 81.8% | 2.09x | 5,183 | 39 |
| BCBS SC (bcbssc.com) | 1,829 | 80.4% | 11.29x | 1,829 | 33 |
| UMR (clearhealthcloud.com) | 1,204 | 94.4% | 2.72x | 1,165 | 33 |
| CIGNA (zelis.com) | 1,080 | 98.0% | 3.64x | 1,080 | 58 |
| UMR (clearhs.com) | 800 | 79.6% | 2.66x | 764 | 31 |
| AETNA (aetna.com) | 635 | 86.9% | 5.34x | 615 | 33 |
| CIGNA (multiplan.com) | 374 | 82.9% | 4.23x | 368 | 67 |
| BCBSTX (bcbstx.com) | 318 | 98.1% | 26.12x † | 288 | 35 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in South Carolina
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 19,273 | $24.1M | $608 | $205 | 5.07x |
| 99285 Emergency department visit with high level of medical decision making | 8,872 | $20.6M | $830 | $256 | 6.17x |
| 99283 Emergency department visit with low level of medical decision making | 2,927 | $1.5M | $405 | $111 | 2.87x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 960 | $234,093 | $278 | $104 | 2.38x |
| 99291 Critical care, first 30-74 minutes | 866 | $984,390 | $980 | $291 | 2.53x |
| 77063 Screening 3D breast mammography | 768 | $1.1M | $1,700 | $87 | 16.75x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 739 | $190,427 | $220 | $153 | 1.72x |
| 77067 Screening mammography | 693 | $1.2M | $2,100 | $109 | 15.94x |
| 71045 X-ray of chest, 1 view | 650 | $370,906 | $1,000 | $16 | 37.26x |
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 524 | $373,263 | $838 | $304 | 2.50x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 483 | $1.4M | $1,817 | $79 | 24.75x |
| 74177 CT scan of abdomen and pelvis with contrast | 425 | $1.6M | $2,500 | $240 | 15.34x |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 314 | $585,102 | $2,359 | $1,155 | 1.84x |
| 00840 Anesthesia for other procedure on lower abdomen | 296 | $423,141 | $1,199 | $689 | 1.91x |
| 71046 X-ray of chest, 2 views | 293 | $198,849 | $1,000 | $19 | 36.36x |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 290 | $195,862 | $804 | $348 | 1.62x |
| 00812 Anesthesia for exam of colon using an endoscope | 279 | $261,849 | $918 | $303 | 3.04x |
| 70450 CT scan head or brain without contrast | 273 | $465,158 | $1,400 | $111 | 12.48x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 237 | $885,143 | $2,229 | $214 | 16.14x |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 220 | $23,467 | $59 | $7 | 6.65x |
| 01400 Anesthesia for other procedure or exam of knee joint using an endoscope | 214 | $199,926 | $784 | $481 | 1.80x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 193 | $1.4M | $4,636 | $548 | 8.07x |
| 64488 Injection of local anesthetic for abdominal wall pain control on both sides usin | 181 | $141,592 | $570 | $181 | 4.14x |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 176 | $133,083 | $628 | $351 | 2.18x |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 170 | $103,025 | $331 | $239 | 2.55x |
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 South Carolina?
In 2025 Q1–Q4, the provider or facility offer was selected in 83.2% of 44,254 determined dispute line items for services provided in South Carolina. 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 South Carolina?
In 2025 Q1–Q4, the median prevailing offer was 3.12x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.73x to 5.95x (n = 43,660 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 South Carolina?
In 2025 Q1–Q4, the median was 40 business days (n = 44,254 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
South Carolina figures count line items whose place of service was South Carolina. See methodology for caveats.