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Other Medicine IDR: win rates and median awards
What Other Medicine providers win in No Surprises Act arbitration, from 5,295 published disputes.
What do Other Medicine providers win at federal IDR? In the CMS federal IDR public use files, providers in Other Medicine won 81.6 percent of decided federal IDR disputes under the No Surprises Act, across 5,295 published disputes. The median award was 4.3x the qualifying payment amount across decided line items in the specialty, and the median time from filing to decision was 29 days. Estimate your own case with the free IDR calculator.
Other 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 Other Medicine billing code, 90471, with a median qualifying payment amount of $63 in the files. A Other Medicine dispute with a qualifying payment amount of $63 resolves at the specialty median of 4.3x, an estimated award of $271. A median is not a floor or a ceiling: half of decided line items in the specialty resolve higher and half lower.
Top Other Medicine billing codes at federal IDR
The most disputed Other 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 |
|---|---|---|---|---|
| 90471 | 4,727 | 81.3% | $63 | $263 |
| 90715 | 3,958 | 81.5% | $73 | $223 |
| 90714 | 733 | 79.6% | $80 | $347 |
| 90675 | 162 | 77.3% | $860 | $3,747 |
| 95012 | 121 | 91.8% | $27 | $103 |
| 90472 | 51 | 62.9% | n/a | n/a |
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 Other Medicine federal IDR disputes do providers win?
Providers won 81.6 percent of decided federal IDR disputes in Other Medicine, across 5,295 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 90471?
Code 90471, the most disputed Other Medicine code in the files, shows a median decided award of $263 against a median qualifying payment amount of $63, with an 81.3 percent provider win rate across 4,727 line items.
How long does a Other Medicine IDR case take?
The median Other Medicine dispute took 29 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
Office & Urgent Care E/M IDR, Other IDR, and Infusion & Drug Administration 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.