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Ancillary HCPCS IDR: win rates and median awards
What Ancillary HCPCS providers win in No Surprises Act arbitration, from 113,777 published disputes.
What do Ancillary HCPCS providers win at federal IDR? In the CMS federal IDR public use files, providers in Ancillary HCPCS won 79.8 percent of decided federal IDR disputes under the No Surprises Act, across 113,777 published disputes. The median award was 3.8x the qualifying payment amount across decided line items in the specialty, and the median time from filing to decision was 28 days. Estimate your own case with the free IDR calculator.
Ancillary HCPCS 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 Ancillary HCPCS billing code, A4670, with a median qualifying payment amount of $12 in the files. A Ancillary HCPCS dispute with a qualifying payment amount of $12 resolves at the specialty median of 3.8x, an estimated award of $46. A median is not a floor or a ceiling: half of decided line items in the specialty resolve higher and half lower.
Top Ancillary HCPCS billing codes at federal IDR
The most disputed Ancillary HCPCS 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 |
|---|---|---|---|---|
| A4670 | 7,674 | 70.4% | $12 | $103 |
| 250 | 7,178 | 87.9% | $8 | $24 |
| 392 | 6,002 | 74.2% | $3,123 | $11,465 |
| A4657 | 5,569 | 72.3% | $48 | $394 |
| A4216 | 4,894 | 74.4% | $7 | $56 |
| A4215 | 4,377 | 74.0% | $8 | $64 |
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 Ancillary HCPCS federal IDR disputes do providers win?
Providers won 79.8 percent of decided federal IDR disputes in Ancillary HCPCS, across 113,777 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 A4670?
Code A4670, the most disputed Ancillary HCPCS code in the files, shows a median decided award of $103 against a median qualifying payment amount of $12, with a 70.4 percent provider win rate across 7,674 line items.
How long does a Ancillary HCPCS IDR case take?
The median Ancillary HCPCS dispute took 28 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
Infusion & Drug Administration IDR, Pathology & Lab IDR, and Other 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.