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Other IDR: win rates and median awards
What Other providers win in No Surprises Act arbitration, from 5,879 published disputes.
What do Other providers win at federal IDR? In the CMS federal IDR public use files, providers in Other won 83.0 percent of decided federal IDR disputes under the No Surprises Act, across 5,879 published disputes. The median award was 7.1x 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.
Other 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 billing code, 99001, with a median qualifying payment amount of $18 in the files. A Other dispute with a qualifying payment amount of $18 resolves at the specialty median of 7.1x, an estimated award of $128. A median is not a floor or a ceiling: half of decided line items in the specialty resolve higher and half lower.
Top Other billing codes at federal IDR
The most disputed Other 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 |
|---|---|---|---|---|
| 99001 | 1,663 | 79.1% | $18 | $184 |
| 99053 | 1,109 | 88.9% | $25 | $240 |
| 99152 | 984 | 87.9% | $19 | $155 |
| 99497 | 715 | 79.8% | $98 | $1,500 |
| 99153 | 277 | 86.7% | $48 | $769 |
| 99406 | 233 | 89.3% | $16 | $75 |
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 federal IDR disputes do providers win?
Providers won 83.0 percent of decided federal IDR disputes in Other, across 5,879 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 99001?
Code 99001, the most disputed Other code in the files, shows a median decided award of $184 against a median qualifying payment amount of $18, with a 79.1 percent provider win rate across 1,663 line items.
How long does a Other IDR case take?
The median Other 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
Other Medicine IDR, Office & Urgent Care E/M IDR, and Ancillary HCPCS 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.