The headline numbers
Providers won 85.8% of the 3.39 million federal IDR disputes resolved from 2023Q1 through 2025Q4, the median provider-won award was 4.7x the qualifying payment amount (QPA), and the median time from filing to determination was 37 days. These are the three numbers that answer most questions about how federal IDR actually resolves, and all three come straight from the CMS Federal IDR public use files rather than survey estimates or case anecdotes.
| Measure | Federal IDR, all disputes |
|---|---|
| Provider win rate | 85.8% |
| Median provider-won award | 4.7x the QPA |
| Median time from filing to determination | 37 days |
| Disputes covered | 3.39 million, 2023Q1 through 2025Q4 |
Win rates and median awards by specialty
Across the 22 specialties in the CMS files, non-default provider win rates range from 73.0% in pulmonary medicine to 89.3% in radiology, and median provider-won awards range from 3.2 times the qualifying payment amount in neonatal and pediatric critical care to 30.3 times in neurosurgery and pain. The table links to a full benchmark page for each specialty, with top service codes, states, and payers.
| Specialty | Disputes | Provider win rate | Median award vs QPA | Median award dollars |
|---|---|---|---|---|
| Emergency Medicine | 1,723,909 | 84.4% | 3.6x | $781 |
| Radiology | 658,921 | 89.3% | 5.7x | $246 |
| Anesthesia | 305,512 | 83.2% | 5.0x | $1,985 |
| IONM and Neurodiagnostics | 270,909 | 84.5% | 27.5x | $3,550 |
| Pathology and Lab | 195,399 | 79.9% | 5.0x | $265 |
| Infusion and Drug Administration | 149,601 | 80.7% | 3.9x | $308 |
| General Surgery | 113,062 | 86.2% | 12.9x | $6,400 |
| Cardiology | 108,746 | 85.4% | 6.9x | $314 |
| Orthopedic Surgery | 94,716 | 84.6% | 25.6x | $9,256 |
| Critical Care | 84,817 | 86.6% | 3.6x | $1,055 |
| Hospital Medicine | 75,021 | 83.1% | 7.9x | $590 |
| Cardiovascular and Thoracic Surgery | 65,425 | 84.7% | 6.0x | $78 |
| Neurosurgery and Pain | 63,176 | 86.2% | 30.3x | $8,250 |
| Pulmonary Medicine | 28,748 | 73.0% | 5.3x | $573 |
| OB/GYN | 13,167 | 87.8% | 25.0x | $25,000 |
| Urology | 9,171 | 88.6% | 14.2x | $10,000 |
| Neonatal and Pediatric Critical Care | 8,111 | 83.6% | 3.2x | $838 |
| Other Medicine | 6,348 | 80.0% | 4.3x | $263 |
| ENT Surgery | 6,052 | 83.5% | 6.5x | $606 |
| Office and Urgent Care E/M | 3,302 | 86.2% | 13.0x | $1,265 |
| PT and Rehab | 1,449 | 76.6% | 5.4x | $283 |
| Ophthalmology | 791 | 82.4% | 8.1x | $1,245 |
How to read these numbers
Counts are dispute level: each dispute is counted once at its latest reporting period, and a dispute can appear under more than one specialty when its line items span categories. The headline 85.8% win rate includes payer no-show defaults; the specialty win rates exclude them, which is why a specialty can sit slightly below the headline figure while still favoring providers. Award multiples are medians over provider-won disputes of each dispute's prevailing offer as a percent of the QPA. Dollar figures are medians from the CMS QPA-and-offers file where enough records support them, so they are benchmarks, not payment records. The files record closed determinations only, which means disputes that settle during open negotiation or are withdrawn never appear here.
Refresh cadence
CMS publishes federal IDR public use files on a rolling schedule, and most prose coverage of the program goes stale between releases. This page is rebuilt from the newest file as soon as CMS posts it, so the vintage in the title always states exactly which quarters the numbers cover. The current build covers 2023Q1 through 2025Q4 and was refreshed on October 28, 2026. For deeper cuts, the federal IDR benchmark hub publishes the same data by service code, state, and payer.
Benchmark your own claims against these numbers
IDR Explorer analyzes CMS Federal IDR public use files by payer, state, specialty, service code, and provider group. Request a free NSA audit to see how claims like yours actually resolve in arbitration.
FAQ
What percentage of federal IDR disputes do providers win?
Providers won 85.8% of the 3.39 million federal IDR disputes resolved through 2025Q4, per CMS public use files. By specialty, non-default win rates range from 73.0% in pulmonary medicine to 89.3% in radiology.
What is the median federal IDR award?
The median provider-won award is 4.7x the qualifying payment amount across all disputes. By specialty, median awards over provider-won disputes range from 3.2x the QPA in neonatal and pediatric critical care to 30.3x in neurosurgery and pain.
Which specialty has the highest IDR win rate?
Radiology has the highest non-default provider win rate at 89.3% across 658,921 disputes. Urology follows at 88.6%.
How long does a federal IDR decision take?
The median time from filing to determination is 37 days. End-to-end recovery takes longer: a 30-business-day open negotiation period must run before filing, and the losing party has 30 calendar days after the determination to pay.
Do these numbers include settlements?
No. The CMS public use files record closed determinations only, so disputes that settle in open negotiation or are withdrawn before a decision are not included.
How often is this page updated?
The page is rebuilt from each new CMS Federal IDR public use file release. The current build covers 3.39 million disputes resolved from 2023Q1 through 2025Q4, and was last refreshed on October 28, 2026.
Sources and references
Providers won 85.8% of 3.39 million federal IDR disputes through 2025Q4, with a median provider-won award of 4.7x the qualifying payment amount, per CMS public use files.
This page is for general informational purposes and is not legal, billing, or reimbursement advice. Outcomes vary by claim mix; benchmark your specific codes, states, and payers before deciding whether to arbitrate.