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Office & Urgent Care E/M IDR: win rates and median awards
What Office & Urgent Care E/M providers win in No Surprises Act arbitration, from 2,679 published disputes.
What do Office & Urgent Care E/M providers win at federal IDR? In the CMS federal IDR public use files, providers in Office & Urgent Care E/M won 85.5 percent of decided federal IDR disputes under the No Surprises Act, across 2,679 published disputes. The median award was 13.6x 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.
Office & Urgent Care E/M 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 Office & Urgent Care E/M billing code, 99214, with a median qualifying payment amount of $90 in the files. A Office & Urgent Care E/M dispute with a qualifying payment amount of $90 resolves at the specialty median of 13.6x, an estimated award of $1,224. A median is not a floor or a ceiling: half of decided line items in the specialty resolve higher and half lower.
Top Office & Urgent Care E/M billing codes at federal IDR
The most disputed Office & Urgent Care E/M 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 |
|---|---|---|---|---|
| 99214 | 769 | 83.6% | $90 | $1,265 |
| 99204 | 538 | 89.0% | $168 | $1,018 |
| 99203 | 478 | 83.5% | $85 | $1,221 |
| 99213 | 363 | 83.5% | $63 | $1,056 |
| 99205 | 208 | 87.6% | $193 | $5,000 |
| 99215 | 153 | 87.4% | $123 | $4,950 |
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 Office & Urgent Care E/M federal IDR disputes do providers win?
Providers won 85.5 percent of decided federal IDR disputes in Office & Urgent Care E/M, across 2,679 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 99214?
Code 99214, the most disputed Office & Urgent Care E/M code in the files, shows a median decided award of $1,265 against a median qualifying payment amount of $90, with an 83.6 percent provider win rate across 769 line items.
How long does a Office & Urgent Care E/M IDR case take?
The median Office & Urgent Care E/M 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
Other Medicine IDR, Emergency Medicine IDR, and Hospital Medicine 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.