Federal IDR outcomes in Texas
In 2025 Q1–Q4, the provider or facility offer prevailed in 85.8% of 2,535,325 determined Federal IDR dispute line items for services provided in Texas. The median prevailing offer was 4.80x the QPA (25th–75th percentile 2.54x–9.38x; n = 2,031,391). The median time to a decision was 32 business days (n = 2,535,325).
Determined line items
2,535,325
2025 Q1–Q4 · 2,466 split decisions excluded
Provider win rate
85.8%
n = 2,535,325 · 2025 Q1–Q4
Median payment vs QPA
4.80x
middle half 2.54x–9.38x · n = 2,031,391 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 2,535,325 · 2025 Q1–Q4
Dollar amounts
Total awarded
$4.52B
sum of prevailing offers · n = 1,531,702 · 2025 Q1–Q4
Total QPA
$567.8M
sum of QPAs, same line items · n = 1,531,702 · 2025 Q1–Q4
Awarded above QPA
$3.95B
total awarded minus total QPA · n = 1,531,702 · 2025 Q1–Q4
Median award per line item
$541
mean $2,951 · n = 1,531,702 · 2025 Q1–Q4
Median QPA
$118
per line item · n = 1,531,702 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
7.96x
total awarded ÷ total QPA · n = 1,531,702 · 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 | 1,531,702 | $4.52B | $567.8M | $3.95B | $541 | $118 | 7.96x |
| 2024 Q3–Q4 | 383,932 | $521.3M | $184.6M | $336.7M | $356 | $81 | 2.82x |
| 2024 Q3–2025 Q4 | 1,915,634 | $5.04B | $752.3M | $4.29B | $489 | $110 | 6.70x |
| 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 | 2,535,325 | 85.8% | 4.80x | 2.54x–9.38x | 2,031,391 | 32 |
| 2024 Q1–Q4 | 826,916 | 84.8% | 5.56x | 3.05x–8.82x | 695,441 | 56 |
| 2023 Q1–Q4 | 98,957 | 72.6% | 4.58x | 1.00x–7.68x | 83,240 | 69 |
| 2023 Q1–2025 Q4 | 3,461,198 | 85.2% | 4.93x | 2.59x–9.07x | 2,810,072 | 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 Texas
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 1,540,380 | 85.2% | 4.76x | 1,257,518 | 29 |
| Radiology | 515,706 | 95.1% | 5.02x | 514,740 | 52 |
| Not reported / unspecified | 212,836 | 65.3% | 1.00x | 24,128 | 27 |
| Hospitals and facilities | 83,292 | 87.3% | 3.22x | 71,585 | 36 |
| Anesthesiology | 79,198 | 86.9% | 3.42x | 74,529 | 30 |
| Intraoperative neuromonitoring | 58,961 | 89.1% | 47.34x † | 47,791 | 32 |
| Surgical assistant services | 21,030 | 90.2% | 34.33x † | 20,492 | 35 |
| Internal and family medicine | 5,491 | 93.7% | 5.48x | 5,023 | 29 |
| Hospital medicine (hospitalists) | 4,138 | 91.9% | 2.93x | 4,094 | 33 |
| General and other surgery | 4,064 | 78.6% | 9.35x | 2,545 | 31 |
| Neurology | 3,184 | 90.8% | 65.87x † | 3,022 | 32 |
| Other / unclassified labels | 2,544 | 83.6% | 8.35x | 1,690 | 26 |
| Orthopedic surgery | 1,577 | 88.0% | 29.84x † | 1,489 | 32 |
| Plastic and reconstructive surgery | 1,305 | 94.9% | 12.79x | 1,259 | 48 |
| Obstetrics and gynecology | 549 | 98.5% | 56.85x † | 492 | 39 |
| Neurosurgery and spine surgery | 299 | 90.3% | 88.68x † | 284 | 32 |
| Infectious disease | 253 | 94.5% | 5.73x | 231 | 41 |
| Critical care | 192 | 95.8% | 4.78x | 178 | 25.5 |
| Cardiothoracic and thoracic surgery | 156 | 87.2% | 12.82x | 137 | 43 |
| Neonatology | 76 | 100.0% | 5.09x | 76 | 365.5 |
| Pain medicine | 33 | 100.0% | 56.82x † | 33 | 34 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Texas
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 354,925 | 83.6% | 4.48x | 330,303 | 29 |
| 99285 Emergency department visit with high level of medical decision making | 140,148 | 83.8% | 3.26x | 125,389 | 34 |
| 99283 Emergency department visit with low level of medical decision making | 139,193 | 81.2% | 4.53x | 129,740 | 26 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 56,927 | 84.4% | 4.66x | 37,158 | 30 |
| 77067 Screening mammography | 56,627 | 95.6% | 2.85x | 56,565 | 67 |
| 77063 Screening 3D breast mammography | 53,015 | 96.3% | 2.49x | 52,954 | 71 |
| 74177 CT scan of abdomen and pelvis with contrast | 51,450 | 89.9% | 7.28x | 46,458 | 39 |
| 71045 X-ray of chest, 1 view | 48,937 | 91.0% | 10.27x | 47,303 | 74 |
| 71046 X-ray of chest, 2 views | 43,770 | 88.1% | 7.36x | 37,836 | 40 |
| 80053 Blood test, comprehensive group of blood chemicals | 43,197 | 85.3% | 4.28x | 29,195 | 30 |
| 70450 CT scan head or brain without contrast | 35,998 | 91.0% | 5.38x | 32,621 | 41 |
| 96375 Injection of additional new drug or substance into vein | 32,422 | 86.3% | 5.45x | 21,333 | 30 |
| 81003 Automated urinalysis test | 32,276 | 82.8% | 5.85x | 19,933 | 28 |
| 96361 Infusion into a vein for hydration, each additional hour | 27,759 | 85.4% | 4.63x | 17,497 | 29 |
| 74176 CT scan of abdomen and pelvis without contrast | 26,141 | 88.4% | 7.19x | 22,542 | 37 |
| 96374 Injection of drug or substance into vein | 25,929 | 84.9% | 4.75x | 16,054 | 29 |
| 96372 Injection of drug or substance under skin or into muscle | 25,228 | 82.1% | 4.12x | 14,725 | 26 |
| 87880 Detection test by immunoassay with direct visual observation for Streptococcus, | 24,337 | 82.7% | 3.62x | 16,739 | 29 |
| 99291 Critical care, first 30-74 minutes | 19,714 | 85.3% | 3.88x | 16,048 | 30 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 19,147 | 84.1% | 4.12x | 12,216 | 29 |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 19,016 | 86.3% | 3.77x | 14,967 | 31 |
| 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 17,752 | 87.0% | 4.08x | 12,071 | 31 |
| 84484 Troponin (protein) analysis, quantitative | 16,921 | 84.4% | 4.63x | 10,260 | 29 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 14,711 | 89.3% | 8.19x | 11,001 | 30 |
| 76705 Limited ultrasound scan of abdomen | 14,603 | 92.0% | 5.14x | 13,446 | 38 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Texas
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 |
|---|---|---|---|---|---|
| BCBSTX (bcbstx.com) | 1,161,145 | 87.8% | 5.92x | 925,864 | 27 |
| AETNA (aetna.com) | 474,110 | 90.4% | 4.52x | 365,537 | 34 |
| UNITED HEALTHCARE (uhc.com) | 394,325 | 80.4% | 4.85x | 286,911 | 42 |
| CIGNA (multiplan.com) | 252,681 | 79.5% | 4.51x | 225,123 | 55 |
| UMR (clearhs.com) | 104,407 | 82.8% | 3.08x | 97,802 | 34 |
| UMR (clearhealthcloud.com) | 36,167 | 83.9% | 3.17x | 34,370 | 36 |
| BCBS OF TX (bcbsil.com) | 35,592 | 80.9% | 1.00x | 35,296 | 97.5 |
| CIGNA (cigna.com) | 10,846 | 87.3% | 5.09x | 8,772 | 42 |
| AMBETTER (centene.com) | 9,840 | 88.8% | 2.25x | 8,441 | 24 |
| HEALTH FIRST (hfbenefits.com) | 7,062 | 68.0% | 6.17x | 7,061 | 33 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Texas
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 256,944 | $1.57B | $1,413 | $259 | 9.69x |
| 99285 Emergency department visit with high level of medical decision making | 103,140 | $652.0M | $1,207 | $381 | 5.54x |
| 99283 Emergency department visit with low level of medical decision making | 98,914 | $725.1M | $1,787 | $373 | 12.78x |
| 77067 Screening mammography | 47,280 | $9.4M | $192 | $67 | 2.79x |
| 77063 Screening 3D breast mammography | 44,496 | $6.0M | $142 | $52 | 2.43x |
| 74177 CT scan of abdomen and pelvis with contrast | 38,263 | $77.2M | $1,100 | $146 | 4.26x |
| 71045 X-ray of chest, 1 view | 36,758 | $6.1M | $122 | $11 | 5.93x |
| 71046 X-ray of chest, 2 views | 28,882 | $10.1M | $142 | $15 | 5.05x |
| 70450 CT scan head or brain without contrast | 26,612 | $26.7M | $414 | $64 | 5.01x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 26,275 | $8.2M | $268 | $58 | 4.00x |
| 80053 Blood test, comprehensive group of blood chemicals | 20,264 | $10.0M | $180 | $89 | 3.72x |
| 74176 CT scan of abdomen and pelvis without contrast | 18,062 | $39.4M | $1,051 | $131 | 4.84x |
| 96375 Injection of additional new drug or substance into vein | 14,481 | $9.7M | $533 | $86 | 4.40x |
| 81003 Automated urinalysis test | 14,208 | $2.8M | $168 | $27 | 3.66x |
| 99291 Critical care, first 30-74 minutes | 12,872 | $52.7M | $1,249 | $339 | 5.19x |
| 96361 Infusion into a vein for hydration, each additional hour | 11,928 | $8.4M | $306 | $98 | 4.07x |
| 87880 Detection test by immunoassay with direct visual observation for Streptococcus, | 11,418 | $3.0M | $188 | $73 | 3.31x |
| 76705 Limited ultrasound scan of abdomen | 11,294 | $4.9M | $300 | $39 | 4.98x |
| 96374 Injection of drug or substance into vein | 10,968 | $6.5M | $393 | $91 | 3.57x |
| 71275 CT scan of blood vessels of chest with contrast | 10,758 | $14.4M | $1,082 | $130 | 5.29x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 10,503 | $52.0M | $4,800 | $51 | 33.25x |
| 87804 Detection test by immunoassay with direct visual observation for influenza virus | 9,894 | $2.8M | $222 | $82 | 3.05x |
| 96372 Injection of drug or substance under skin or into muscle | 9,859 | $4.5M | $335 | $86 | 2.84x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 9,115 | $145.4M | $5,382 | $282 | 23.34x |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 8,749 | $5.6M | $518 | $123 | 4.11x |
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 Texas?
In 2025 Q1–Q4, the provider or facility offer was selected in 85.8% of 2,535,325 determined dispute line items for services provided in Texas. 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 Texas?
In 2025 Q1–Q4, the median prevailing offer was 4.80x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.54x to 9.38x (n = 2,031,391 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 Texas?
In 2025 Q1–Q4, the median was 32 business days (n = 2,535,325 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Texas figures count line items whose place of service was Texas. See methodology for caveats, including thin early Texas volume.