Federal IDR outcomes in Washington
In 2025 Q1–Q4, the provider or facility offer prevailed in 88.7% of 14,332 determined Federal IDR dispute line items for services provided in Washington. The median prevailing offer was 2.37x the QPA (25th–75th percentile 1.85x–3.00x; n = 13,618). The median time to a decision was 29 business days (n = 14,332).
Determined line items
14,332
2025 Q1–Q4 · 6 split decisions excluded
Provider win rate
88.7%
n = 14,332 · 2025 Q1–Q4
Median payment vs QPA
2.37x
middle half 1.85x–3.00x · n = 13,618 · 2025 Q1–Q4
Median days to decision
29
business days, from dispute initiation · n = 14,332 · 2025 Q1–Q4
Dollar amounts
Total awarded
$14.8M
sum of prevailing offers · n = 15,401 · 2025 Q1–Q4
Total QPA
$4.4M
sum of QPAs, same line items · n = 15,401 · 2025 Q1–Q4
Awarded above QPA
$10.4M
total awarded minus total QPA · n = 15,401 · 2025 Q1–Q4
Median award per line item
$573
mean $958 · n = 15,401 · 2025 Q1–Q4
Median QPA
$252
per line item · n = 15,401 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.38x
total awarded ÷ total QPA · n = 15,401 · 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 | 15,401 | $14.8M | $4.4M | $10.4M | $573 | $252 | 3.38x |
| 2024 Q3–Q4 | 1,783 | $1.6M | $19.1M | −$17.4M | $704 | $179 | 0.08x |
| 2024 Q3–2025 Q4 | 17,184 | $16.4M | $23.4M | −$7.1M | $573 | $247 | 0.70x |
| 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 | 14,332 | 88.7% | 2.37x | 1.85x–3.00x | 13,618 | 29 |
| 2024 Q1–Q4 | 2,664 | 90.2% | 2.92x | 2.67x–3.85x | 2,584 | 38.5 |
| 2023 Q1–Q4 | 295 | 75.6% | 3.13x | 1.89x–7.49x | 289 | 93 |
| 2023 Q1–2025 Q4 | 17,291 | 88.7% | 2.57x | 1.91x–3.13x | 16,491 | 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 Washington
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 12,274 | 90.6% | 2.30x | 12,034 | 29 |
| Intraoperative neuromonitoring | 1,223 | 90.4% | 12.88x | 786 | 31 |
| Not reported / unspecified | 306 | 13.7% | 1.05x | 270 | 40 |
| Internal and family medicine | 105 | 92.4% | 3.61x | 105 | 36 |
| Neurosurgery and spine surgery | 105 | 83.8% | 61.38x † | 105 | 26 |
| Anesthesiology | 80 | 100.0% | 3.98x | 80 | 32 |
| Obstetrics and gynecology | 72 | 88.9% | 38.53x † | 71 | 31.5 |
| Other / unclassified labels | 68 | 70.6% | 0.80x | 68 | 25 |
| Plastic and reconstructive surgery | 47 | 76.6% | 79.86x † | 47 | 28 |
| Hospitals and facilities | 30 | 70.0% | 1.72x | 30 | 41 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Washington
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99285 Emergency department visit with high level of medical decision making | 5,558 | 90.0% | 2.11x | 5,525 | 28 |
| 99284 Emergency department visit with moderate level of medical decision making | 4,579 | 89.6% | 2.27x | 4,553 | 30 |
| 99283 Emergency department visit with low level of medical decision making | 995 | 94.5% | 3.58x | 992 | 25 |
| 99291 Critical care, first 30-74 minutes | 669 | 90.0% | 2.06x | 667 | 30 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 325 | 89.8% | 22.77x † | 231 | 29 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 254 | 89.0% | 8.53x | 195 | 30 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 213 | 87.8% | 10.45x | 162 | 31 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 105 | 95.2% | 10.60x | 48 | 31 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 96 | 94.8% | 39.56x † | 33 | 32.5 |
| 95937 Testing of nerve-muscle junction | 70 | 94.3% | – | 25 | 31 |
| 58662 Destruction or removal of ovary or growth of pelvis using an endoscope | 50 | 82.0% | 63.48x † | 50 | 29 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 48 | 89.6% | 10.16x | 46 | 24 |
| 95870 Needle measurement of electrical activity in arm, leg, trunk or head muscles, li | 48 | 85.4% | – | 23 | 32.5 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 48 | 75.0% | 4.03x | 48 | 25 |
| 00812 Anesthesia for exam of colon using an endoscope | 42 | 100.0% | 3.98x | 42 | 32.5 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 30 | 73.3% | – | 23 | 58.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Washington
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 |
|---|---|---|---|---|---|
| AETNA (aetna.com) | 9,133 | 93.4% | 2.31x | 9,068 | 25 |
| UNITED HEALTHCARE (uhc.com) | 1,401 | 79.7% | 2.77x | 1,301 | 46 |
| UMR (clearhs.com) | 854 | 80.7% | 1.61x | 801 | 27 |
| CIGNA (multiplan.com) | 566 | 79.2% | 1.90x | 447 | 39 |
| REGENCE BLUECROSS BLUESHIELD OF OREGON (regence.com) | 436 | 85.1% | 9.24x | 390 | 25 |
| PREMERA BLUE CROSS (premera.com) | 282 | 72.3% | 8.81x | 259 | 34 |
| UMR (clearhealthcloud.com) | 281 | 81.5% | 2.44x | 276 | 40 |
| KAISER FOUNDATION (kp.org) | 147 | 97.3% | 6.09x | 135 | 25 |
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 109 | 92.7% | 23.36x † | 60 | 24 |
| KAISER PERMANENTE OF WA (kaiserpermanente.org) | 101 | 100.0% | 1.90x | 101 | 46 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Washington
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99285 Emergency department visit with high level of medical decision making | 5,103 | $4.5M | $761 | $361 | 2.24x |
| 99284 Emergency department visit with moderate level of medical decision making | 4,218 | $2.4M | $558 | $245 | 2.36x |
| 99283 Emergency department visit with low level of medical decision making | 916 | $357,144 | $384 | $98 | 3.45x |
| 99291 Critical care, first 30-74 minutes | 519 | $493,657 | $903 | $441 | 2.17x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 480 | $867,658 | $1,817 | $81 | 15.68x |
| 71045 X-ray of chest, 1 view | 431 | $11,519 | $27 | $18 | 1.52x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 313 | $708,337 | $2,229 | $213 | 8.74x |
| 77067 Screening mammography | 311 | $25,720 | $77 | $60 | 1.22x |
| 77063 Screening 3D breast mammography | 277 | $15,170 | $48 | $48 | 0.86x |
| 71046 X-ray of chest, 2 views | 272 | $10,824 | $31 | $21 | 1.87x |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 249 | $1.1M | $3,550 | $413 | 5.07x |
| 74177 CT scan of abdomen and pelvis with contrast | 187 | $67,434 | $376 | $142 | 2.51x |
| 70450 CT scan head or brain without contrast | 181 | $23,284 | $124 | $82 | 1.74x |
| 74018 X-ray of abdomen, 1 view | 125 | $4,562 | $38 | $14 | 3.16x |
| 76642 Limited ultrasound scan of 1 breast | 106 | $9,611 | $62 | $45 | 1.94x |
| 76641 Complete ultrasound scan of 1 breast | 105 | $12,260 | $152 | $34 | 2.90x |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 101 | $123,281 | $915 | $181 | 6.67x |
| 73630 X-ray of foot, minimum of 3 views | 75 | $1,781 | $14 | $13 | 1.90x |
| 73030 X-ray of shoulder, minimum of 2 views | 67 | $1,810 | $20 | $15 | 2.11x |
| 73562 X-ray of knee, 3 views | 55 | $1,397 | $22 | $14 | 2.00x |
| 73610 X-ray of ankle, minimum of 3 views | 55 | $1,480 | $20 | $14 | 2.11x |
| 72125 CT scan of upper spine without contrast | 50 | $7,206 | $124 | $98 | 2.20x |
| 73130 X-ray of hand, minimum of 3 views | 44 | $1,054 | $19 | $14 | 1.78x |
| 76856 Complete ultrasound scan of pelvis | 42 | $2,756 | $54 | $54 | 1.35x |
| 70498 CT scan of blood vessels of neck with contrast | 41 | $11,128 | $309 | $161 | 1.64x |
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 Washington?
In 2025 Q1–Q4, the provider or facility offer was selected in 88.7% of 14,332 determined dispute line items for services provided in Washington. 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 Washington?
In 2025 Q1–Q4, the median prevailing offer was 2.37x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.85x to 3.00x (n = 13,618 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 Washington?
In 2025 Q1–Q4, the median was 29 business days (n = 14,332 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Washington figures count line items whose place of service was Washington. See methodology for caveats.