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Critical Care IDR: win rates and median awards
What Critical Care providers win in No Surprises Act arbitration, from 52,569 published disputes.
What do Critical Care providers win at federal IDR? In the CMS federal IDR public use files, providers in Critical Care won 88.0 percent of decided federal IDR disputes under the No Surprises Act, across 52,569 published disputes. The median award was 3.7x the qualifying payment amount across decided line items in the specialty, and the median time from filing to decision was 31 days. Estimate your own case with the free IDR calculator.
Critical Care line items in the CMS federal IDR public use files, 2023 through 2025. Method on the methodology page.
A worked example
Take the most disputed Critical Care billing code, 99291, with a median qualifying payment amount of $315 in the files. A Critical Care dispute with a qualifying payment amount of $315 resolves at the specialty median of 3.7x, an estimated award of $1,166. A median is not a floor or a ceiling: half of decided line items in the specialty resolve higher and half lower.
Top Critical Care billing codes at federal IDR
The most disputed Critical Care codes in the public use files, at the line-item grain. Median award is the median decided award in dollars for that code. Win rates are within decided line items for the code.
| Code | Line items | Win rate | Median QPA | Median award |
|---|---|---|---|---|
| 99291 | 52,132 | 88.0% | $315 | $1,077 |
| 99292 | 1,838 | 83.6% | $233 | $2,400 |
Source: CMS federal IDR public use files, 2023 through 2025. "n/a" means CMS did not publish a usable dollar figure for that code.
Common questions
What percentage of Critical Care federal IDR disputes do providers win?
Providers won 88.0 percent of decided federal IDR disputes in Critical Care, across 52,569 disputes in the CMS federal IDR public use files. Decided disputes exclude default decisions, where one side never submitted an offer.
What is the median IDR award for code 99291?
Code 99291, the most disputed Critical Care code in the files, shows a median decided award of $1,077 against a median qualifying payment amount of $315, with an 88.0 percent provider win rate across 52,132 line items.
How long does a Critical Care IDR case take?
The median Critical Care dispute took 31 days from filing to decision. The No Surprises Act process is written only: after the payer's initial payment there are 30 business days to start open negotiation, 30 to negotiate, then 4 to initiate arbitration. There is no hearing.
Related pages
Emergency Medicine IDR, Hospital Medicine IDR, and Neonatal & Pediatric Critical Care IDR have their own pages, and the IDR calculator covers all 22 specialties. For filing help, Lido IDR files federal IDR for a flat fee per arbitration. To browse every published dispute, see idrexplorer.com.