What CPT 99284 represents in IDR
Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
For IDR strategy, the code-level view matters because payer behavior can look different after the QPA, state, and service category are held constant. Use this page to compare your CPT 99284 disputes against the CMS benchmark before escalating volume.
CPT 99284 outcomes by state
Top payers for CPT 99284
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| UnitedHealthcare | 171,142 | 86.3% | 3.0x |
| BCBSTX | 142,689 | 83.9% | 8.3x |
| Aetna | 66,099 | 87.4% | 3.6x |
| Anthem Blue Cross | 43,705 | 88.2% | 3.7x |
| Cigna / MultiPlan | 43,326 | 77.6% | 4.9x |
| UMR | 25,502 | 83.2% | 3.6x |
| UMR (clearhealthcloud.com) | 23,064 | 90.1% | 2.9x |
| BCBSOK | 13,893 | 83.7% | 10.3x |
Recent CPT 99284 quarterly trend
| Quarter | Disputes | Provider win rate | Median award |
|---|---|---|---|
| 2025Q1 | 114,784 | 86.6% | 3.5x |
| 2025Q2 | 162,282 | 86.6% | 3.8x |
| 2025Q3 | 177,505 | 85.4% | 4.3x |
| 2025Q4 | 148,623 | 81.7% | 4.7x |
Open CPT 99284 in the explorer
Filter CPT 99284 by state, year, and payer to compare the public benchmark with your own out-of-network payment experience.
FAQ
How many CPT 99284 IDR disputes are in the dataset?
This benchmark shows 603,194 CPT 99284 disputes.
What is the CPT 99284 median award multiple?
The median provider-won award is 4.0x QPA.
Why compare CPT 99284 by state and payer?
State and payer mix can change both QPA and outcomes, so a code-level national average should be narrowed before deciding how to route disputes.
Related benchmarks
Sources and method
- CMS: Federal IDR reports and public use files
- CMS: About Independent Dispute Resolution
- CMS: Federal IDR timeline for claims
Data source: CMS Federal IDR public use files, coverage through 2025Q4; data build 2026-09-21. Counts are CMS dispute counts unless a table says line items. Win rates labeled non-default exclude payer no-show defaults. Award multiples are medians versus QPA. Dollar figures, where shown, are anchored estimates from CMS QPA-and-offer fields, not payment records. This page is informational, not legal or reimbursement advice.