What Infusion and Drug Administration teams should benchmark
Infusion and Drug Administration 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 Infusion and Drug Administration service codes
| Code | Service | Disputes | Provider win rate | Median award | Median award dollars |
|---|---|---|---|---|---|
| 96375 | IV push injection, each additional drug | 53,976 | 82.5% | 5.5x | $547 |
| 96374 | IV push injection, single or initial drug | 52,328 | 81.2% | 4.0x | $454 |
| 96361 | IV hydration, each additional hour | 48,608 | 81.9% | 4.9x | $354 |
| 96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneo | 35,664 | 79.3% | 4.8x | $344 |
| J7030 | Normal saline IV solution, 1,000 mL | 33,952 | 78.1% | 4.2x | $97 |
| J1885 | Ketorolac (Toradol) injection, 15 mg | 31,040 | 77.3% | 4.3x | $38 |
| 96365 | IV infusion therapy, initial hour | 26,667 | 83.3% | 3.9x | $538 |
| J2405 | Ondansetron (Zofran) anti-nausea injection, 1 mg | 23,364 | 78% | 3.9x | $32 |
| S5001 | Prescription drug, brand name | 12,742 | 92.7% | 3.3x | $19 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 12,153 | 73.2% | 5.4x | $200 |
| 96376 | IV push injection, each additional dose of the same drug | 10,450 | 82.6% | 5.7x | $334 |
| 96360 | IV hydration, initial 31-60 minutes | 10,060 | 81.1% | 3.0x | $562 |
| S5000 | Prescription drug, generic | 10,020 | 92.5% | 3.4x | $3 |
| J0696 | Ceftriaxone (Rocephin) antibiotic injection, 250 mg | 9,369 | 75.3% | 4.5x | $114 |
| J2270 | Morphine sulfate injection, 10 mg | 9,185 | 80% | 3.7x | $28 |
All Infusion and Drug Administration benchmark codes
| Code | Service | Disputes |
|---|---|---|
| 96375 | IV push injection, each additional drug | 53,976 |
| 96374 | IV push injection, single or initial drug | 52,328 |
| 96361 | IV hydration, each additional hour | 48,608 |
| 96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneo | 35,664 |
| J7030 | Normal saline IV solution, 1,000 mL | 33,952 |
| J1885 | Ketorolac (Toradol) injection, 15 mg | 31,040 |
| 96365 | IV infusion therapy, initial hour | 26,667 |
| J2405 | Ondansetron (Zofran) anti-nausea injection, 1 mg | 23,364 |
| S5001 | Prescription drug, brand name | 12,742 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 12,153 |
| 96376 | IV push injection, each additional dose of the same drug | 10,450 |
| 96360 | IV hydration, initial 31-60 minutes | 10,060 |
| S5000 | Prescription drug, generic | 10,020 |
| J0696 | Ceftriaxone (Rocephin) antibiotic injection, 250 mg | 9,369 |
| J2270 | Morphine sulfate injection, 10 mg | 9,185 |
| J8499 | Oral prescription drug, non-chemotherapy (unspecified) | 7,320 |
| J3490 | Unclassified injectable drug | 5,196 |
| J1200 | Diphenhydramine (Benadryl) injection, up to 50 mg | 5,028 |
| 96366 | IV infusion therapy, each additional hour | 4,954 |
| 96367 | IV infusion, additional sequential drug, up to 1 hour | 4,659 |
| J7120 | Lactated Ringer's IV solution, up to 1,000 mL | 4,063 |
| J0131 | Acetaminophen (IV Ofirmev) injection, 10 mg | 3,972 |
| J2765 | Metoclopramide (Reglan) injection, 10 mg | 3,244 |
| J2919 | Methylprednisolone (Solu-Medrol) injection, 5 mg | 3,186 |
| 96523 | Irrigation of implanted venous access drug delivery device | 2,974 |
| 96368 | IV infusion, concurrent additional drug | 2,968 |
| J7620 | Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, | 2,320 |
| J2550 | Injection, promethazine hcl, up to 50 mg | 2,302 |
| J2060 | Injection, lorazepam, 2 mg | 2,273 |
| J7040 | Infusion, normal saline solution, sterile (500 ml = 1 unit) | 2,217 |
| J2543 | Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) | 1,924 |
| J2003 | Injection, lidocaine hydrochloride, 1 mg | 1,858 |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 1,840 |
| J2470 | Injection, pantoprazole sodium, 40 mg | 1,792 |
| J1171 | Injection, hydromorphone, 0.1 mg | 1,670 |
| J1170 | Injection, hydromorphone, up to 4 mg | 1,528 |
| J0780 | Injection, prochlorperazine, up to 10 mg | 1,432 |
| J7050 | Infusion, normal saline solution, 250 cc | 1,399 |
| J3475 | Injection, magnesium sulfate, per 500 mg | 1,141 |
| J1650 | Injection, enoxaparin sodium, 10 mg | 1,127 |
| J2704 | Injection, propofol, 10 mg | 1,100 |
| J8540 | Dexamethasone, oral, 0.25 mg | 1,098 |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 1,052 |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered t | 953 |
| J2001 | Injection, lidocaine hcl for intravenous infusion, 10 mg | 949 |
| J1308 | Injection, famotidine, 0.25 mg | 923 |
| J0500 | Injection, dicyclomine hcl, up to 20 mg | 914 |
| J0690 | Injection, cefazolin sodium, 500 mg | 913 |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | 894 |
| J2930 | Injection, methylprednisolone sodium succinate, up to 125 mg | 838 |
| J0360 | Injection, hydralazine hcl, up to 20 mg | 756 |
| J2360 | Injection, orphenadrine citrate, up to 60 mg | 743 |
| J1815 | Injection, insulin, per 5 units | 721 |
| J0134 | Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg | 717 |
| J1836 | Injection, metronidazole, 10 mg | 705 |
| J7060 | 5% dextrose/water (500 ml = 1 unit) | 666 |
| J1630 | Injection, haloperidol, up to 5 mg | 659 |
| J2004 | Injection, lidocaine hcl with epinephrine, 1 mg | 657 |
| J1644 | Injection, heparin sodium, per 1000 units | 578 |
| J3370 | Injection, vancomycin hcl, 500 mg | 573 |
| J3480 | Injection, potassium chloride, per 2 meq | 558 |
| J0171 | Injection, adrenalin, epinephrine, 0.1 mg | 554 |
Top states for Infusion and Drug Administration disputes
| State | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Texas | 93,201 | 79.4% | 4.6x |
| Tennessee | 8,212 | 82.3% | 1.4x |
| Arizona | 8,075 | 75.7% | 3.8x |
| California | 6,710 | 88.1% | 2.2x |
| Arkansas | 5,494 | 84.2% | 5.2x |
| Oklahoma | 3,583 | 91.7% | 6.0x |
| Mississippi | 3,546 | 85.1% | 2.1x |
| New Mexico | 2,183 | 91.3% | 4.5x |
| Kansas | 1,318 | 85.7% | 3.4x |
| Michigan | 1,277 | 94.3% | 3.0x |
Top payers in Infusion and Drug Administration
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| BCBSTX | 60,182 | 81.4% | 5.1x |
| UnitedHealthcare | 15,764 | 77% | 1.1x |
| Aetna | 15,489 | 83.8% | 2.0x |
| Cigna / MultiPlan | 12,454 | 75% | 4.5x |
| Cigna | 7,627 | 84.6% | 1.7x |
| UMR (clearhs.com) | 7,405 | 81.4% | 3.5x |
| BCBSAZ | 4,936 | 74.7% | 3.5x |
| AMBETTER | 4,388 | 95.1% | 2.7x |
| Anthem Blue Cross | 4,039 | 89.8% | 3.0x |
| UMR (clearhealthcloud.com) | 2,477 | 79.6% | 3.8x |
Filing checklist before you take Infusion and Drug Administration claims to IDR
- Confirm the claim is NSA-eligible: emergency care, or out-of-network care at an in-network facility, with no state arbitration law that displaces the federal process for that plan type.
- Start open negotiation within 30 business days of the initial payment or denial notice. The negotiation window then runs 30 business days.
- If negotiation fails, initiate federal IDR through the portal within 4 business days after the window closes.
- Batch same-payer items in the same service code category. Open negotiation periods starting on or after November 1, 2026 can batch up to 50 line items per dispute, up from 25.
- Budget for fees: the federal administrative fee is $15 per party for disputes initiated on or after June 11, 2026 (down from $115), and the non-prevailing party pays the certified IDR entity fee.
- Anchor your offer to the data: the Infusion and Drug Administration median provider-won award is 3.9x QPA across 149,601 disputes.
The fee and batching changes come from the May 2026 federal IDR operations final rule. See the 2026 and 2027 No Surprises Act changes guide for the full timeline, or request a free NSA audit to see how your claims compare.
Open the Infusion and Drug Administration dashboard
Filter Infusion and Drug Administration disputes by state, payer, and year to compare the public benchmark with your own out-of-network payment experience.
FAQ
How many Infusion and Drug Administration federal IDR disputes are in the dataset?
This benchmark shows 149,601 Infusion and Drug Administration disputes.
What is the Infusion and Drug Administration provider win rate?
The non-default provider win rate is 80.7%.
What should Infusion and Drug Administration 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.
What changes in 2026 and 2027 affect Infusion and Drug Administration IDR filings?
The administrative fee dropped to $15 per party for disputes initiated on or after June 11, 2026, batching expands to 50 line items for open negotiation periods starting on or after November 1, 2026, and standardized CARC/RARC remittance codes arrive January 1, 2027.
Related benchmarks
Sources and method
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.
- CMS: Federal IDR reports and public use files
- CMS: Federal IDR operations final rule fact sheet
- CMS: Federal IDR timeline for claims
Data source: CMS Federal IDR public use files, coverage through 2025Q4; data build 2026-09-24. Counts are CMS dispute counts unless a table says line items. Win rates on this page exclude payer no-show defaults unless labeled otherwise. Award multiples are medians versus the qualifying payment amount (QPA). Dollar figures, where shown, come from CMS QPA-and-offer fields or are anchored estimates, not payment records. This page is informational, not legal or reimbursement advice.