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Hospital Medicine IDR: win rates and median awards
What Hospital Medicine providers win in No Surprises Act arbitration, from 60,968 published disputes.
What do Hospital Medicine providers win at federal IDR? In the CMS federal IDR public use files, providers in Hospital Medicine won 83.9 percent of decided federal IDR disputes under the No Surprises Act, across 60,968 published disputes. The median award was 8.1x the qualifying payment amount across decided line items in the specialty, and the median time from filing to decision was 30 days. Estimate your own case with the free IDR calculator.
Hospital Medicine 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 Hospital Medicine billing code, G0378, with a median qualifying payment amount of $1,055 in the files. A Hospital Medicine dispute with a qualifying payment amount of $1,055 resolves at the specialty median of 8.1x, an estimated award of $8,546. A median is not a floor or a ceiling: half of decided line items in the specialty resolve higher and half lower.
Top Hospital Medicine billing codes at federal IDR
The most disputed Hospital Medicine 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 |
|---|---|---|---|---|
| G0378 | 14,331 | 79.8% | $1,055 | $14,400 |
| 99223 | 11,595 | 85.7% | $238 | $1,000 |
| 99232 | 9,794 | 86.0% | $85 | $292 |
| 99233 | 8,973 | 84.1% | $126 | $462 |
| 99239 | 6,386 | 83.8% | $128 | $411 |
| 99222 | 5,473 | 85.7% | $163 | $1,564 |
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 Hospital Medicine federal IDR disputes do providers win?
Providers won 83.9 percent of decided federal IDR disputes in Hospital Medicine, across 60,968 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 G0378?
Code G0378, the most disputed Hospital Medicine code in the files, shows a median decided award of $14,400 against a median qualifying payment amount of $1,055, with a 79.8 percent provider win rate across 14,331 line items.
How long does a Hospital Medicine IDR case take?
The median Hospital Medicine dispute took 30 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
Critical Care IDR, Emergency Medicine IDR, and Office & Urgent Care E/M 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.