Federal IDR outcomes in Wisconsin
In 2025 Q1–Q4, the provider or facility offer prevailed in 83.3% of 21,042 determined Federal IDR dispute line items for services provided in Wisconsin. The median prevailing offer was 3.33x the QPA (25th–75th percentile 1.75x–9.59x; n = 18,875). The median time to a decision was 32 business days (n = 21,042).
Determined line items
21,042
2025 Q1–Q4 · 25 split decisions excluded
Provider win rate
83.3%
n = 21,042 · 2025 Q1–Q4
Median payment vs QPA
3.33x
middle half 1.75x–9.59x · n = 18,875 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 21,042 · 2025 Q1–Q4
Dollar amounts
Total awarded
$82.9M
sum of prevailing offers · n = 65,508 · 2025 Q1–Q4
Total QPA
$27.2M
sum of QPAs, same line items · n = 65,508 · 2025 Q1–Q4
Awarded above QPA
$55.7M
total awarded minus total QPA · n = 65,508 · 2025 Q1–Q4
Median award per line item
$604
mean $1,266 · n = 65,508 · 2025 Q1–Q4
Median QPA
$175
per line item · n = 65,508 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
3.04x
total awarded ÷ total QPA · n = 65,508 · 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 | 65,508 | $82.9M | $27.2M | $55.7M | $604 | $175 | 3.04x |
| 2024 Q3–Q4 | 14,696 | $17.3M | $13.7M | $3.6M | $483 | $131 | 1.27x |
| 2024 Q3–2025 Q4 | 80,204 | $100.2M | $40.9M | $59.3M | $584 | $166 | 2.45x |
| 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 | 21,042 | 83.3% | 3.33x | 1.75x–9.59x | 18,875 | 32 |
| 2024 Q1–Q4 | 5,652 | 77.5% | 3.70x | 1.33x–17.24x | 4,381 | 80 |
| 2023 Q1–Q4 | 617 | 84.1% | 1.88x | 1.00x–9.47x | 284 | 42 |
| 2023 Q1–2025 Q4 | 27,311 | 82.1% | 3.33x | 1.66x–11.11x | 23,540 | 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 Wisconsin
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 12,223 | 81.4% | 2.30x | 10,891 | 30 |
| Intraoperative neuromonitoring | 2,833 | 84.9% | 11.46x | 2,723 | 32 |
| Neurosurgery and spine surgery | 2,449 | 94.4% | 23.84x † | 2,225 | 43 |
| Anesthesiology | 1,566 | 77.5% | 1.96x | 1,552 | 26 |
| Other / unclassified labels | 511 | 92.2% | 23.03x † | 227 | 34 |
| Vascular surgery | 419 | 98.3% | 16.80x | 283 | 40 |
| Neonatology | 359 | 79.1% | 2.25x | 359 | 35 |
| Not reported / unspecified | 157 | 20.4% | 1.00x | 120 | 36 |
| Hospital medicine (hospitalists) | 150 | 84.7% | 1.29x | 150 | 43 |
| Neurology | 108 | 82.4% | 24.38x † | 107 | 31 |
| General and other surgery | 107 | 94.4% | 5.61x | 78 | 53 |
| Hospitals and facilities | 88 | 83.0% | 1.00x | 88 | 27 |
| Internal and family medicine | 48 | 95.8% | 4.37x | 48 | 23 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Wisconsin
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 2,858 | 77.3% | 1.89x | 2,618 | 31 |
| 99285 Emergency department visit with high level of medical decision making | 2,310 | 77.4% | 2.14x | 1,948 | 34 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 961 | 84.9% | 18.78x | 929 | 33 |
| 99283 Emergency department visit with low level of medical decision making | 728 | 80.9% | 2.33x | 621 | 31 |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 572 | 85.8% | 9.03x | 559 | 30 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 473 | 86.3% | 5.24x | 282 | 32 |
| 99291 Critical care, first 30-74 minutes | 417 | 83.0% | 2.68x | 377 | 29 |
| 95941 Continuous remote monitoring of nervous system during operation, each hour | 334 | 87.7% | 9.75x | 321 | 36 |
| 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 309 | 95.8% | 18.84x | 240 | 42 |
| 80053 Blood test, comprehensive group of blood chemicals | 308 | 81.2% | 2.96x | 305 | 30 |
| 99204 New patient office or other outpatient visit with moderate level of medical deci | 254 | 88.6% | 1.71x | 219 | 26.5 |
| 81003 Automated urinalysis test | 246 | 81.7% | 3.76x | 246 | 30.5 |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 237 | 84.4% | 3.28x | 236 | 25 |
| 62321 Injection of substance into middle or upper spine canal using imaging guidance | 227 | 96.0% | 17.65x | 186 | 37 |
| 96374 Injection of drug or substance into vein | 211 | 81.0% | 2.14x | 209 | 31 |
| 96361 Infusion into a vein for hydration, each additional hour | 196 | 81.6% | 2.58x | 194 | 28 |
| 96375 Injection of additional new drug or substance into vein | 195 | 77.9% | 2.33x | 194 | 27 |
| 87637 Detection test by multiplex amplified probe technique for severe acute respirato | 179 | 81.0% | 2.33x | 178 | 31 |
| 64772 Incision or removal of spinal nerve | 176 | 92.0% | 40.32x † | 151 | 51 |
| 71046 X-ray of chest, 2 views | 172 | 86.6% | 2.96x | 168 | 28 |
| 64484 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 168 | 97.0% | 23.71x † | 114 | 40 |
| 64493 Injection of lower or sacral spine facet joint using imaging guidance, single le | 165 | 93.3% | 19.43x | 142 | 41 |
| 95861 Needle measurement of electrical activity in arm or leg muscles, 2 extremities | 164 | 86.6% | 14.95x | 151 | 28.5 |
| 99152 Use of a drug to induce depression of consciousness by physician performing a pr | 154 | 96.1% | 11.54x | 104 | 40 |
| 64490 Injection of upper or middle spine facet joint using imaging guidance, single le | 151 | 96.7% | 19.60x | 127 | 46 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Wisconsin
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 |
|---|---|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 7,302 | 83.6% | 3.33x | 6,747 | 30 |
| UNITED HEALTHCARE (uhc.com) | 4,756 | 80.2% | 5.37x | 4,104 | 49 |
| UMR (clearhs.com) | 3,977 | 77.6% | 2.61x | 3,466 | 30 |
| AETNA (aetna.com) | 805 | 84.3% | 2.10x | 764 | 34 |
| UMR (clearhealthcloud.com) | 762 | 86.4% | 2.35x | 697 | 27 |
| CIGNA (zelis.com) | 717 | 99.7% | 6.15x | 561 | 26 |
| CIGNA (cigna.com) | 440 | 78.0% | 2.30x | 429 | 26 |
| CIGNA (multiplan.com) | 237 | 82.7% | 8.31x | 213 | 27 |
| CARESOURCE MARKETPLACE (caresource.com) | 236 | 76.7% | 2.08x | 236 | 25 |
| MEDICA (medica.com) | 211 | 100.0% | 4.24x | 196 | 26 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Wisconsin
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 14,140 | $14.8M | $695 | $238 | 3.15x |
| 99285 Emergency department visit with high level of medical decision making | 8,358 | $11.0M | $852 | $325 | 2.20x |
| 99283 Emergency department visit with low level of medical decision making | 3,533 | $5.5M | $1,577 | $257 | 2.91x |
| 77063 Screening 3D breast mammography | 2,042 | $266,094 | $130 | $51 | 2.53x |
| 77067 Screening mammography | 2,042 | $396,910 | $193 | $67 | 2.51x |
| 71046 X-ray of chest, 2 views | 1,596 | $673,652 | $137 | $18 | 3.91x |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 1,295 | $3.0M | $1,817 | $80 | 14.80x |
| 74177 CT scan of abdomen and pelvis with contrast | 1,234 | $2.9M | $1,030 | $162 | 4.38x |
| 71045 X-ray of chest, 1 view | 1,214 | $138,586 | $107 | $16 | 5.53x |
| 99291 Critical care, first 30-74 minutes | 995 | $1.3M | $1,012 | $327 | 2.78x |
| 70450 CT scan head or brain without contrast | 832 | $1.1M | $388 | $69 | 4.31x |
| 87637 Detection test by multiplex amplified probe technique for severe acute respirato | 791 | $527,523 | $750 | $264 | 2.74x |
| 80053 Blood test, comprehensive group of blood chemicals | 749 | $557,921 | $824 | $168 | 3.69x |
| 00812 Anesthesia for exam of colon using an endoscope | 699 | $1.0M | $1,704 | $249 | 5.71x |
| 95939 Placement of skin electrodes and measurement of central motor stimulation in arm | 699 | $1.9M | $2,229 | $234 | 9.11x |
| 76705 Limited ultrasound scan of abdomen | 595 | $217,752 | $294 | $48 | 6.03x |
| 76642 Limited ultrasound scan of 1 breast | 580 | $196,147 | $299 | $63 | 5.33x |
| 74176 CT scan of abdomen and pelvis without contrast | 573 | $796,247 | $984 | $155 | 4.55x |
| 81003 Automated urinalysis test | 567 | $106,330 | $194 | $36 | 3.11x |
| 76830 Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina | 548 | $212,977 | $319 | $56 | 5.22x |
| 71275 CT scan of blood vessels of chest with contrast | 541 | $714,435 | $1,014 | $155 | 4.41x |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 483 | $131,762 | $309 | $70 | 3.00x |
| 76856 Complete ultrasound scan of pelvis | 458 | $183,371 | $309 | $56 | 5.05x |
| 76815 Limited ultrasound of pregnant uterus | 402 | $118,757 | $290 | $52 | 5.06x |
| 85027 Complete blood cell count (red cells, white blood cell, platelets), automated te | 397 | $86,855 | $225 | $52 | 3.57x |
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 Wisconsin?
In 2025 Q1–Q4, the provider or facility offer was selected in 83.3% of 21,042 determined dispute line items for services provided in Wisconsin. 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 Wisconsin?
In 2025 Q1–Q4, the median prevailing offer was 3.33x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.75x to 9.59x (n = 18,875 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 Wisconsin?
In 2025 Q1–Q4, the median was 32 business days (n = 21,042 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Wisconsin figures count line items whose place of service was Wisconsin. See methodology for caveats.