Federal IDR outcomes: Neonatology in South Carolina
In 2025 Q1–Q4, the provider or facility offer prevailed in 84.1% of 1,856 determined Federal IDR dispute line items for neonatology in South Carolina. The median prevailing offer was 2.44x the QPA (25th–75th percentile 1.91x–3.64x; n = 1,830). The median time to a decision was 39 business days (n = 1,856).
Determined line items
1,856
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
84.1%
n = 1,856 · 2025 Q1–Q4
Median payment vs QPA
2.44x
middle half 1.91x–3.64x · n = 1,830 · 2025 Q1–Q4
Median days to decision
39
business days, from dispute initiation · n = 1,856 · 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 | 1,856 | 84.1% | 2.44x | 1.91x–3.64x | 1,830 | 39 |
| 2024 Q1–Q4 | 1,132 | 78.4% | 2.70x | 2.05x–4.04x | 1,132 | 210 |
| 2023 Q1–Q4 | 198 | 79.8% | 4.40x | 2.49x–6.13x | 198 | 41.5 |
| 2023 Q1–2025 Q4 | 3,186 | 81.8% | 2.58x | 2.00x–4.04x | 3,160 | 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 |
|---|---|---|---|---|---|
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 591 | 87.1% | 2.44x | 565 | 40 |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 323 | 84.2% | 2.38x | 323 | 34 |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 302 | 77.5% | 2.17x | 302 | 37 |
| 99472 Follow-up inpatient hospital critical care of infant or young child per day (29 | 109 | 86.2% | 5.05x | 109 | 57 |
| 99468 Initial inpatient hospital critical care of newborn per day (28 days or younger) | 90 | 87.8% | 1.67x | 90 | 33 |
| 92650 Screening evaluation of brain response to sound with automated analysis | 87 | 90.8% | 4.85x | 87 | 107 |
| 99239 Hospital discharge day management, more than 30 minutes | 74 | 77.0% | 4.94x | 74 | 34 |
| 99477 Initial intensive care of newborn per day (28 days or younger) | 63 | 82.5% | 2.26x | 63 | 30 |
| 99478 Follow-up intensive care of recovering very low birth weight infant per day | 58 | 96.6% | 3.34x | 58 | 65 |
| 99238 Hospital discharge day management, 30 minutes or less | 39 | 69.2% | 5.20x | 39 | 99 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in South Carolina · Neonatology in all states
FAQ
What is the Federal IDR provider win rate for neonatology in South Carolina?
In 2025 Q1–Q4, the provider or facility offer was selected in 84.1% of 1,856 determined dispute line items for neonatology 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 neonatology in South Carolina?
In 2025 Q1–Q4, the median prevailing offer was 2.44x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.91x to 3.64x (n = 1,830 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 neonatology in South Carolina?
In 2025 Q1–Q4, the median was 39 business days (n = 1,856 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).