Federal IDR outcomes in Tennessee
In 2025 Q1–Q4, the provider or facility offer prevailed in 83.8% of 231,229 determined Federal IDR dispute line items for services provided in Tennessee. The median prevailing offer was 2.84x the QPA (25th–75th percentile 1.79x–4.36x; n = 193,057). The median time to a decision was 43 business days (n = 231,229).
Determined line items
231,229
2025 Q1–Q4 · 244 split decisions excluded
Provider win rate
83.8%
n = 231,229 · 2025 Q1–Q4
Median payment vs QPA
2.84x
middle half 1.79x–4.36x · n = 193,057 · 2025 Q1–Q4
Median days to decision
43
business days, from dispute initiation · n = 231,229 · 2025 Q1–Q4
Dollar amounts
Total awarded
$214.9M
sum of prevailing offers · n = 192,824 · 2025 Q1–Q4
Total QPA
$72.3M
sum of QPAs, same line items · n = 192,824 · 2025 Q1–Q4
Awarded above QPA
$142.6M
total awarded minus total QPA · n = 192,824 · 2025 Q1–Q4
Median award per line item
$606
mean $1,115 · n = 192,824 · 2025 Q1–Q4
Median QPA
$174
per line item · n = 192,824 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
2.97x
total awarded ÷ total QPA · n = 192,824 · 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 | 192,824 | $214.9M | $72.3M | $142.6M | $606 | $174 | 2.97x |
| 2024 Q3–Q4 | 81,840 | $88.4M | $29.5M | $58.9M | $539 | $141 | 3.00x |
| 2024 Q3–2025 Q4 | 274,664 | $303.3M | $101.8M | $201.5M | $584 | $168 | 2.98x |
| 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 | 231,229 | 83.8% | 2.84x | 1.79x–4.36x | 193,057 | 43 |
| 2024 Q1–Q4 | 138,528 | 81.1% | 2.89x | 1.70x–4.33x | 110,877 | 106 |
| 2023 Q1–Q4 | 52,350 | 84.4% | 2.95x | 2.03x–3.21x | 49,913 | 71 |
| 2023 Q1–2025 Q4 | 422,107 | 83.0% | 2.89x | 1.78x–4.17x | 353,847 | 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 Tennessee
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Hospitals and facilities | 91,201 | 86.0% | 2.82x | 62,835 | 46 |
| Emergency medicine and emergency departments | 87,652 | 82.9% | 3.16x | 83,719 | 45 |
| Anesthesiology | 18,270 | 88.4% | 2.21x | 17,378 | 39 |
| Hospital medicine (hospitalists) | 10,208 | 90.1% | 2.80x | 10,048 | 43 |
| Not reported / unspecified | 7,021 | 45.2% | 1.20x | 2,609 | 37 |
| Intraoperative neuromonitoring | 6,158 | 81.5% | 19.49x | 5,832 | 31 |
| Neonatology | 4,883 | 87.1% | 2.00x | 4,863 | 54 |
| Radiology | 2,599 | 93.6% | 2.40x | 2,597 | 32 |
| Other / unclassified labels | 1,194 | 72.8% | 1.00x | 1,185 | 50 |
| Obstetrics and gynecology | 1,124 | 67.5% | 1.00x | 1,119 | 44 |
| Neurology | 380 | 78.4% | 37.54x † | 368 | 40.5 |
| Critical care | 257 | 93.0% | 11.31x | 246 | 22 |
| Internal and family medicine | 194 | 83.5% | 6.00x | 194 | 84 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Tennessee
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 46,116 | 83.5% | 2.87x | 44,929 | 44 |
| 99285 Emergency department visit with high level of medical decision making | 31,686 | 80.1% | 3.40x | 30,012 | 49 |
| 99283 Emergency department visit with low level of medical decision making | 10,245 | 86.0% | 2.79x | 10,019 | 48 |
| 80053 Blood test, comprehensive group of blood chemicals | 5,697 | 83.1% | 9.02x | 3,737 | 43 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 5,205 | 83.6% | 3.58x | 3,406 | 44 |
| 36415 Insertion of needle into vein for collection of blood sample | 4,540 | 86.2% | 2.79x | 1,217 | 57 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 4,195 | 90.5% | 3.00x | 4,079 | 53 |
| 84484 Troponin (protein) analysis, quantitative | 3,591 | 82.9% | 2.81x | 2,346 | 42 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 3,568 | 85.7% | 2.72x | 2,380 | 44 |
| 99291 Critical care, first 30-74 minutes | 3,512 | 86.8% | 3.45x | 3,372 | 39 |
| 74177 CT scan of abdomen and pelvis with contrast | 3,223 | 82.2% | 2.72x | 2,762 | 37 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 2,940 | 87.2% | 2.82x | 2,926 | 37 |
| 71045 X-ray of chest, 1 view | 2,574 | 85.5% | 2.44x | 1,935 | 43 |
| 81001 Manual urinalysis test with examination using microscope, automated | 2,429 | 83.8% | 6.53x | 1,642 | 41 |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 2,420 | 85.0% | 3.28x | 1,503 | 45 |
| 70450 CT scan head or brain without contrast | 2,163 | 82.8% | 3.66x | 1,782 | 38 |
| 96374 Injection of drug or substance into vein | 1,977 | 82.7% | 1.00x | 1,072 | 55 |
| 83735 Magnesium level | 1,887 | 83.3% | 4.48x | 1,205 | 43 |
| 81420 Test for detecting genes associated with fetal disease, aneuploidy genomic seque | 1,877 | 63.3% | 1.00x | 1,871 | 50 |
| 84703 Gonadotropin (reproductive hormone) analysis | 1,871 | 84.4% | 5.18x | 1,277 | 43 |
| 99239 Hospital discharge day management, more than 30 minutes | 1,774 | 90.2% | 2.80x | 1,770 | 41 |
| 96375 Injection of additional new drug or substance into vein | 1,602 | 84.5% | 1.68x | 660 | 54 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 1,581 | 91.7% | 2.17x | 1,572 | 43 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 1,526 | 82.0% | 32.46x † | 1,451 | 32 |
| 83690 Lipase (fat enzyme) level | 1,521 | 83.1% | 5.05x | 1,015 | 44 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Tennessee
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) | 86,315 | 86.7% | 2.69x | 62,032 | 52 |
| CIGNA (cigna.com) | 71,023 | 82.2% | 3.01x | 66,019 | 38 |
| CIGNA (multiplan.com) | 24,344 | 76.5% | 3.35x | 23,217 | 39 |
| BLUECROSS BLUESHIELD OF TENNESSEE (bcbst.com) | 11,538 | 68.4% | 2.53x | 11,084 | 98 |
| UMR (clearhs.com) | 11,282 | 84.9% | 2.41x | 10,948 | 36 |
| AMBETTER (centene.com) | 9,882 | 94.9% | 3.27x | 4,787 | 50 |
| CIGNA (zelis.com) | 6,154 | 93.8% | 3.62x | 5,374 | 45 |
| UMR (clearhealthcloud.com) | 3,502 | 87.8% | 2.07x | 3,425 | 41 |
| BCBSTX (bcbstx.com) | 1,440 | 92.3% | 16.90x | 1,344 | 29 |
| AETNA (aetna.com) | 1,008 | 86.0% | 1.23x | 898 | 40 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Tennessee
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 46,243 | $46.6M | $624 | $232 | 3.07x |
| 99285 Emergency department visit with high level of medical decision making | 31,378 | $42.5M | $853 | $257 | 2.72x |
| 99283 Emergency department visit with low level of medical decision making | 9,801 | $7.6M | $414 | $153 | 2.40x |
| 80053 Blood test, comprehensive group of blood chemicals | 5,470 | $2.9M | $606 | $65 | 5.99x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 4,981 | $593,482 | $120 | $37 | 3.02x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 3,646 | $1.1M | $278 | $89 | 3.22x |
| 84484 Troponin (protein) analysis, quantitative | 3,412 | $841,342 | $225 | $83 | 3.20x |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 3,320 | $985,138 | $293 | $111 | 2.50x |
| 99291 Critical care, first 30-74 minutes | 3,194 | $3.4M | $1,010 | $283 | 3.14x |
| 74177 CT scan of abdomen and pelvis with contrast | 2,896 | $9.2M | $1,785 | $772 | 3.80x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 2,643 | $1.2M | $385 | $130 | 3.33x |
| 81001 Manual urinalysis test with examination using microscope, automated | 2,448 | $271,558 | $134 | $20 | 4.65x |
| 71045 X-ray of chest, 1 view | 2,416 | $597,214 | $280 | $103 | 2.32x |
| 70450 CT scan head or brain without contrast | 2,087 | $3.6M | $2,041 | $522 | 3.31x |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 2,076 | $404,020 | $249 | $75 | 2.57x |
| 83735 Magnesium level | 1,961 | $307,247 | $188 | $38 | 4.30x |
| 99239 Hospital discharge day management, more than 30 minutes | 1,529 | $581,488 | $376 | $130 | 2.73x |
| 83690 Lipase (fat enzyme) level | 1,476 | $313,423 | $251 | $48 | 4.11x |
| 87635 Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronav | 1,338 | $175,281 | $130 | $65 | 1.04x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 1,307 | $5.1M | $1,817 | $66 | 31.48x |
| 84703 Gonadotropin (reproductive hormone) analysis | 1,305 | $268,402 | $233 | $43 | 4.00x |
| 36415 Insertion of needle into vein for collection of blood sample | 1,258 | $77,110 | $29 | $11 | 1.50x |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 1,172 | $644,259 | $521 | $249 | 2.27x |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 1,079 | $2.2M | $1,937 | $1,353 | 1.71x |
| 00840 Anesthesia for other procedure on lower abdomen | 1,065 | $1.3M | $1,030 | $490 | 2.13x |
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 Tennessee?
In 2025 Q1–Q4, the provider or facility offer was selected in 83.8% of 231,229 determined dispute line items for services provided in Tennessee. 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 Tennessee?
In 2025 Q1–Q4, the median prevailing offer was 2.84x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.79x to 4.36x (n = 193,057 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 Tennessee?
In 2025 Q1–Q4, the median was 43 business days (n = 231,229 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Tennessee figures count line items whose place of service was Tennessee. See methodology for caveats.