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Pathology & Lab IDR: win rates and median awards
What Pathology & Lab providers win in No Surprises Act arbitration, from 164,354 published disputes.
What do Pathology & Lab providers win at federal IDR? In the CMS federal IDR public use files, providers in Pathology & Lab won 81.0 percent of decided federal IDR disputes under the No Surprises Act, across 164,354 published disputes. The median award was 5.0x 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.
Pathology & Lab 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 Pathology & Lab billing code, 85025, with a median qualifying payment amount of $47 in the files. A Pathology & Lab dispute with a qualifying payment amount of $47 resolves at the specialty median of 5.0x, an estimated award of $235. A median is not a floor or a ceiling: half of decided line items in the specialty resolve higher and half lower.
Top Pathology & Lab billing codes at federal IDR
The most disputed Pathology & Lab 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 |
|---|---|---|---|---|
| 85025 | 93,474 | 82.0% | $47 | $268 |
| 80053 | 74,243 | 81.9% | $74 | $621 |
| 81003 | 48,474 | 80.0% | $26 | $194 |
| 84484 | 30,936 | 81.7% | $80 | $344 |
| 87880 | 28,967 | 79.8% | $61 | $217 |
| 81025 | 21,409 | 82.3% | $34 | $143 |
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 Pathology & Lab federal IDR disputes do providers win?
Providers won 81.0 percent of decided federal IDR disputes in Pathology & Lab, across 164,354 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 85025?
Code 85025, the most disputed Pathology & Lab code in the files, shows a median decided award of $268 against a median qualifying payment amount of $47, with an 82.0 percent provider win rate across 93,474 line items.
How long does a Pathology & Lab IDR case take?
The median Pathology & Lab 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
Infusion & Drug Administration IDR, Radiology & Imaging 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.