What Emergency Medicine teams should benchmark
Emergency Medicine IDR outcomes are shaped by code mix. The same payer can look fair in one lane and misaligned in another. Start with the codes that dominate your disputed claims, then compare state and payer behavior.
The purpose of this page is to help a specialty leader or RCM team decide where the federal IDR data supports a closer claim-level review.
Top Emergency Medicine service codes
| Code | Service | Disputes | Provider win rate | Median award | Median award dollars |
|---|---|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 603,194 | 85% | 4.0x | $720 |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 303,070 | 86.7% | 3.4x | $914 |
| 99283 | Emergency department visit for the evaluation and management of a patient. Modifier... | 215,893 | 81.1% | 4.8x | $1,750 |
| 99282 | Emergency department visit, low to moderate severity | 7,636 | 78.5% | 7.0x | $1,581 |
| 99281 | Service code in the CMS Federal IDR data | 928 | 68% | 14.5x | $3,218 |
Top states for Emergency Medicine disputes
Top payers in Emergency Medicine
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| UnitedHealthcare | 278,253 | 85% | 3.0x |
| BCBSTX | 250,327 | 83.4% | 7.8x |
| Aetna | 137,992 | 88.4% | 3.2x |
| Anthem Blue Cross | 91,941 | 88.9% | 3.5x |
| Cigna / MultiPlan | 90,125 | 77.6% | 4.7x |
| UMR | 50,210 | 83.1% | 3.4x |
| UMR (clearhealthcloud.com) | 45,919 | 90.1% | 2.8x |
| Cigna (cigna.com) | 27,435 | 79.9% | 3.6x |
Open the Emergency Medicine dashboard
Filter the live explorer by state, payer, and year to compare Emergency Medicine outcomes against your own claim mix.
FAQ
How many Emergency Medicine federal IDR disputes are in the dataset?
This benchmark shows 1,130,093 Emergency Medicine disputes.
What is the Emergency Medicine provider win rate?
The non-default provider win rate is 84.6%.
What should Emergency Medicine groups compare first?
Start with service-code mix, then narrow by payer and state. That sequence usually gives a more useful answer than a national specialty average.
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.