Federal IDR outcomes in South Dakota
In 2025 Q1–Q4, the provider or facility offer prevailed in 63.5% of 2,017 determined Federal IDR dispute line items for services provided in South Dakota. The median prevailing offer was 4.18x the QPA (25th–75th percentile 1.71x–6.29x; n = 1,869). The median time to a decision was 26 business days (n = 2,017).
Determined line items
2,017
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
63.5%
n = 2,017 · 2025 Q1–Q4
Median payment vs QPA
4.18x
middle half 1.71x–6.29x · n = 1,869 · 2025 Q1–Q4
Median days to decision
26
business days, from dispute initiation · n = 2,017 · 2025 Q1–Q4
Dollar amounts
Total awarded
$1.3M
sum of prevailing offers · n = 1,592 · 2025 Q1–Q4
Total QPA
$396,808
sum of QPAs, same line items · n = 1,592 · 2025 Q1–Q4
Awarded above QPA
$856,027
total awarded minus total QPA · n = 1,592 · 2025 Q1–Q4
Median award per line item
$783
mean $787 · n = 1,592 · 2025 Q1–Q4
Median QPA
$210
per line item · n = 1,592 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.16x
total awarded ÷ total QPA · n = 1,592 · 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 | 1,592 | $1.3M | $396,808 | $856,027 | $783 | $210 | 3.16x |
| 2024 Q3–Q4 | 252 | $215,012 | $73,405 | $141,607 | $783 | $266 | 2.93x |
| 2024 Q3–2025 Q4 | 1,844 | $1.5M | $470,214 | $997,634 | $783 | $210 | 3.12x |
| 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 | 2,017 | 63.5% | 4.18x | 1.71x–6.29x | 1,869 | 26 |
| 2024 Q1–Q4 | 221 | 86.4% | 11.75x | 4.41x–18.68x | 199 | 49 |
| 2023 Q1–Q4 | 30 | 76.7% | – | – | 29 | 46.5 |
| 2023 Q1–2025 Q4 | 2,268 | 65.9% | 4.18x | 1.71x–7.29x | 2,097 | 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 Dakota
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Anesthesiology | 1,398 | 54.9% | 2.86x | 1,398 | 25 |
| Intraoperative neuromonitoring | 498 | 88.8% | 16.29x | 444 | 29.5 |
| Not reported / unspecified | 102 | 52.9% | – | 11 | 36 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in South Dakota
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 00812 Anesthesia for exam of colon using an endoscope | 187 | 59.9% | 5.01x | 187 | 26 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 141 | 87.9% | 41.31x † | 129 | 29 |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 108 | 44.4% | 1.71x | 108 | 27 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 104 | 86.5% | 12.74x | 89 | 30 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 95 | 94.7% | 16.45x | 81 | 37 |
| 00170 Anesthesia for other procedure on mouth | 76 | 55.3% | 4.18x | 76 | 27 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 63 | 85.7% | 15.04x | 57 | 27 |
| 00811 Anesthesia for other procedure on large bowel using an endoscope | 59 | 54.2% | 4.18x | 59 | 30 |
| 00813 Anesthesia for procedure on small and large bowel using an endoscope | 57 | 68.4% | 4.18x | 57 | 22 |
| 00840 Anesthesia for other procedure on lower abdomen | 57 | 50.9% | 3.92x | 57 | 28 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 57 | 87.7% | 27.23x † | 53 | 33 |
| 01967 Anesthesia for labor during planned vaginal delivery | 50 | 64.0% | 3.58x | 50 | 28 |
| 01830 Anesthesia for other procedure on forearm, wrist, or hand bones | 36 | 55.6% | 4.18x | 36 | 21 |
| 00790 Anesthesia for other procedure on upper abdomen | 34 | 47.1% | 1.71x | 34 | 26 |
| 00300 Anesthesia for other procedure on skin, muscles, or nerves of head, neck, and up | 33 | 54.5% | 3.80x | 33 | 23 |
| 00126 Anesthesia for incision of ear drum | 30 | 43.3% | 1.71x | 30 | 27.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in South Dakota
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 |
|---|---|---|---|---|---|
| AVERA HEALTH PLANS INC. (avera.org) | 1,311 | 52.3% | 1.71x | 1,311 | 25 |
| BCBSTX (bcbstx.com) | 327 | 88.4% | 17.41x | 287 | 32 |
| AETNA (aetna.com) | 89 | 92.1% | 5.94x | 88 | 17 |
| UNITED HEALTHCARE (uhc.com) | 72 | 69.4% | 5.07x | 63 | 38.5 |
| ALLIED BENEFIT SYSTEMS (alliedbenefit.com) | 39 | 100.0% | – | 4 | 21 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in South Dakota
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 354 | $237,579 | $783 | $189 | 3.31x |
| 99285 Emergency department visit with high level of medical decision making | 193 | $180,621 | $1,077 | $375 | 2.73x |
| 00812 Anesthesia for exam of colon using an endoscope | 185 | $115,569 | $750 | $150 | 4.13x |
| 00731 Anesthesia for other procedure on esophagus, stomach, or upper small bowel using | 104 | $67,466 | $410 | $210 | 3.04x |
| 00170 Anesthesia for other procedure on mouth | 73 | $66,826 | $1,000 | $269 | 3.42x |
| 99291 Critical care, first 30-74 minutes | 68 | $87,092 | $1,393 | $352 | 3.46x |
| 00811 Anesthesia for other procedure on large bowel using an endoscope | 58 | $37,507 | $750 | $180 | 3.47x |
| 00840 Anesthesia for other procedure on lower abdomen | 57 | $69,993 | $1,125 | $359 | 3.01x |
| 00813 Anesthesia for procedure on small and large bowel using an endoscope | 56 | $49,468 | $938 | $233 | 3.84x |
| 01967 Anesthesia for labor during planned vaginal delivery | 50 | $31,172 | $750 | $193 | 2.63x |
| 01830 Anesthesia for other procedure on forearm, wrist, or hand bones | 35 | $31,639 | $1,000 | $240 | 3.36x |
| 00300 Anesthesia for other procedure on skin, muscles, or nerves of head, neck, and up | 33 | $34,696 | $1,125 | $299 | 3.32x |
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 Dakota?
In 2025 Q1–Q4, the provider or facility offer was selected in 63.5% of 2,017 determined dispute line items for services provided in South Dakota. 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 Dakota?
In 2025 Q1–Q4, the median prevailing offer was 4.18x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.71x to 6.29x (n = 1,869 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 Dakota?
In 2025 Q1–Q4, the median was 26 business days (n = 2,017 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
South Dakota figures count line items whose place of service was South Dakota. See methodology for caveats.