Federal IDR outcomes: Internal and family medicine in Texas
In 2025 Q1–Q4, the provider or facility offer prevailed in 93.7% of 5,491 determined Federal IDR dispute line items for internal and family medicine in Texas. The median prevailing offer was 5.48x the QPA (25th–75th percentile 2.46x–8.83x; n = 5,023). The median time to a decision was 29 business days (n = 5,491).
Determined line items
5,491
2025 Q1–Q4 · 14 split decisions excluded
Provider win rate
93.7%
n = 5,491 · 2025 Q1–Q4
Median payment vs QPA
5.48x
middle half 2.46x–8.83x · n = 5,023 · 2025 Q1–Q4
Median days to decision
29
business days, from dispute initiation · n = 5,491 · 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 | 5,491 | 93.7% | 5.48x | 2.46x–8.83x | 5,023 | 29 |
| 2024 Q1–Q4 | 228 | 95.2% | 7.62x | 5.00x–10.55x | 193 | 36 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 5,719 | 93.7% | 5.51x | 2.53x–8.95x | 5,216 | 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 |
|---|---|---|---|---|---|
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 729 | 93.6% | 2.33x | 694 | 26 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 638 | 93.9% | 5.44x | 568 | 28 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 572 | 96.3% | 6.16x | 404 | 32 |
| 99291 Critical care, first 30-74 minutes | 557 | 93.5% | 5.95x | 544 | 32 |
| 99238 Hospital discharge day management, 30 minutes or less | 522 | 95.4% | 6.22x | 497 | 25 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 385 | 92.2% | 5.92x | 312 | 29 |
| 99239 Hospital discharge day management, more than 30 minutes | 231 | 93.5% | 6.68x | 186 | 28 |
| 99236 Initial hospital care with same-day admission and discharge with high level of m | 188 | 88.3% | 2.04x | 187 | 27 |
| 99235 Initial hospital care with same-day admission and discharge with moderate level | 187 | 90.4% | 2.95x | 186 | 23 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 160 | 94.4% | 9.40x | 156 | 35 |
| 99284 Emergency department visit with moderate level of medical decision making | 109 | 93.6% | 15.04x | 109 | 26 |
| 99283 Emergency department visit with low level of medical decision making | 82 | 80.5% | 26.16x † | 82 | 24 |
| 99214 Established patient office or other outpatient visit with moderate level of deci | 44 | 93.2% | 10.77x | 41 | 26 |
| 99285 Emergency department visit with high level of medical decision making | 42 | 95.2% | 8.55x | 42 | 24.5 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 34 | 97.1% | 4.36x | 33 | 36 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Texas · Internal and family medicine in all states
FAQ
What is the Federal IDR provider win rate for internal and family medicine in Texas?
In 2025 Q1–Q4, the provider or facility offer was selected in 93.7% of 5,491 determined dispute line items for internal and family medicine 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 internal and family medicine in Texas?
In 2025 Q1–Q4, the median prevailing offer was 5.48x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.46x to 8.83x (n = 5,023 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 internal and family medicine in Texas?
In 2025 Q1–Q4, the median was 29 business days (n = 5,491 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).