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Pulmonary Medicine IDR: win rates and median awards
What Pulmonary Medicine providers win in No Surprises Act arbitration, from 21,078 published disputes.
What do Pulmonary Medicine providers win at federal IDR? In the CMS federal IDR public use files, providers in Pulmonary Medicine won 77.7 percent of decided federal IDR disputes under the No Surprises Act, across 21,078 published disputes. The median award was 5.3x 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.
Pulmonary 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 Pulmonary Medicine billing code, 94640, with a median qualifying payment amount of $104 in the files. A Pulmonary Medicine dispute with a qualifying payment amount of $104 resolves at the specialty median of 5.3x, an estimated award of $551. A median is not a floor or a ceiling: half of decided line items in the specialty resolve higher and half lower.
Top Pulmonary Medicine billing codes at federal IDR
The most disputed Pulmonary 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 |
|---|---|---|---|---|
| 94640 | 9,726 | 82.5% | $104 | $438 |
| 94761 | 9,310 | 70.4% | $73 | $749 |
| 94760 | 2,267 | 77.3% | $53 | $267 |
| 94644 | 188 | 78.1% | $140 | $321 |
| 94645 | 88 | 61.1% | $134 | $1,396 |
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 Pulmonary Medicine federal IDR disputes do providers win?
Providers won 77.7 percent of decided federal IDR disputes in Pulmonary Medicine, across 21,078 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 94640?
Code 94640, the most disputed Pulmonary Medicine code in the files, shows a median decided award of $438 against a median qualifying payment amount of $104, with an 82.5 percent provider win rate across 9,726 line items.
How long does a Pulmonary Medicine IDR case take?
The median Pulmonary 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
Cardiology IDR, Critical Care 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.