Federal IDR outcomes: Emergency medicine and emergency departments in Wisconsin
In 2025 Q1–Q4, the provider or facility offer prevailed in 81.4% of 12,223 determined Federal IDR dispute line items for emergency medicine and emergency departments in Wisconsin. The median prevailing offer was 2.30x the QPA (25th–75th percentile 1.55x–4.90x; n = 10,891). The median time to a decision was 30 business days (n = 12,223).
Determined line items
12,223
2025 Q1–Q4 · 10 split decisions excluded
Provider win rate
81.4%
n = 12,223 · 2025 Q1–Q4
Median payment vs QPA
2.30x
middle half 1.55x–4.90x · n = 10,891 · 2025 Q1–Q4
Median days to decision
30
business days, from dispute initiation · n = 12,223 · 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 | 12,223 | 81.4% | 2.30x | 1.55x–4.90x | 10,891 | 30 |
| 2024 Q1–Q4 | 2,482 | 73.9% | 1.46x | 1.05x–1.87x | 1,340 | 137 |
| 2023 Q1–Q4 | 420 | 88.6% | 1.37x | 1.00x–1.56x | 111 | 32 |
| 2023 Q1–2025 Q4 | 15,125 | 80.3% | 2.14x | 1.42x–4.47x | 12,342 | 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 |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 2,810 | 77.8% | 1.89x | 2,570 | 31 |
| 99285 Emergency department visit with high level of medical decision making | 2,268 | 77.7% | 2.14x | 1,911 | 34 |
| 99283 Emergency department visit with low level of medical decision making | 722 | 81.0% | 2.33x | 615 | 30.5 |
| 93010 Routine electrocardiogram (ECG) using at least 12 leads with interpretation and | 469 | 86.1% | 5.29x | 278 | 32 |
| 99291 Critical care, first 30-74 minutes | 385 | 86.2% | 2.88x | 346 | 29 |
| 80053 Blood test, comprehensive group of blood chemicals | 307 | 81.1% | 2.98x | 304 | 30 |
| 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 | 236 | 84.3% | 3.31x | 235 | 25 |
| 99204 New patient office or other outpatient visit with moderate level of medical deci | 233 | 95.3% | 1.83x | 198 | 27 |
| 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 | 195 | 81.5% | 2.58x | 193 | 28 |
| 96375 Injection of additional new drug or substance into vein | 194 | 77.8% | 2.35x | 193 | 27 |
| 87637 Detection test by multiplex amplified probe technique for severe acute respirato | 178 | 80.9% | 2.33x | 177 | 31 |
| 71046 X-ray of chest, 2 views | 168 | 87.5% | 2.96x | 166 | 28 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 150 | 75.3% | 2.35x | 147 | 45 |
| 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | 135 | 85.2% | 2.15x | 132 | 27 |
| 99214 Established patient office or other outpatient visit with moderate level of deci | 120 | 90.8% | 1.50x | 65 | 40 |
| 81025 Urine pregnancy test | 104 | 85.6% | 2.38x | 104 | 29 |
| 84484 Troponin (protein) analysis, quantitative | 103 | 81.6% | 2.14x | 103 | 27 |
| 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 86 | 81.4% | 2.14x | 85 | 25.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Wisconsin · Emergency medicine and emergency departments in all states
FAQ
What is the Federal IDR provider win rate for emergency medicine and emergency departments in Wisconsin?
In 2025 Q1–Q4, the provider or facility offer was selected in 81.4% of 12,223 determined dispute line items for emergency medicine and emergency departments 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 emergency medicine and emergency departments in Wisconsin?
In 2025 Q1–Q4, the median prevailing offer was 2.30x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.55x to 4.90x (n = 10,891 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 emergency medicine and emergency departments in Wisconsin?
In 2025 Q1–Q4, the median was 30 business days (n = 12,223 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).