Federal IDR outcomes: Critical care in Texas
In 2025 Q1–Q4, the provider or facility offer prevailed in 95.8% of 192 determined Federal IDR dispute line items for critical care in Texas. The median prevailing offer was 4.78x the QPA (25th–75th percentile 3.32x–9.27x; n = 178). The median time to a decision was 25.5 business days (n = 192).
Determined line items
192
2025 Q1–Q4 · 4 split decisions excluded
Provider win rate
95.8%
n = 192 · 2025 Q1–Q4
Median payment vs QPA
4.78x
middle half 3.32x–9.27x · n = 178 · 2025 Q1–Q4
Median days to decision
25.5
business days, from dispute initiation · n = 192 · 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 | 192 | 95.8% | 4.78x | 3.32x–9.27x | 178 | 25.5 |
| 2024 Q1–Q4 | 183 | 94.0% | 5.29x | 2.38x–5.70x | 160 | 52 |
| 2023 Q1–Q4 | 128 | 89.8% | 5.31x | 2.25x–5.64x | 123 | 27 |
| 2023 Q1–2025 Q4 | 503 | 93.6% | 5.24x | 2.42x–5.92x | 461 | 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 |
|---|---|---|---|---|---|
| 99190 Assembly and operation of heart-lung machine, each hour | 49 | 95.9% | 4.08x | 37 | 25 |
| 99191 Assembly and operation of heart-lung machine, 45 minutes | 30 | 96.7% | 4.40x | 30 | 24.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Texas · Critical care in all states
FAQ
What is the Federal IDR provider win rate for critical care in Texas?
In 2025 Q1–Q4, the provider or facility offer was selected in 95.8% of 192 determined dispute line items for critical care 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 Withdrawn, settled and ineligible disputes are not in the CMS data.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 critical care in Texas?
In 2025 Q1–Q4, the median prevailing offer was 4.78x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 3.32x to 9.27x (n = 178 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 critical care in Texas?
In 2025 Q1–Q4, the median was 25.5 business days (n = 192 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).