What Pathology and Lab teams should benchmark
Pathology and Lab 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 Pathology and Lab service codes
| Code | Service | Disputes | Provider win rate | Median award | Median award dollars |
|---|---|---|---|---|---|
| 85025 | Complete blood count (CBC) with automated differential | 93,474 | 82% | 4.8x | $268 |
| 80053 | Comprehensive metabolic panel (14 blood chemistry tests) | 74,243 | 81.9% | 6.3x | $621 |
| 81003 | Urinalysis, automated, without microscopy | 48,474 | 80% | 7.3x | $194 |
| 84484 | Troponin blood test (cardiac injury marker), quantitative | 30,936 | 81.7% | 4.6x | $344 |
| 87880 | Rapid strep A test | 28,967 | 79.8% | 4.4x | $217 |
| 81025 | Urine pregnancy test | 21,409 | 82.3% | 4.9x | $143 |
| 82150 | Amylase blood test (pancreas enzyme) | 18,936 | 78.7% | 7.5x | $318 |
| 87804 | Rapid influenza test | 18,489 | 85.1% | 3.6x | $249 |
Top states for Pathology and Lab disputes
| State | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Texas | 97,851 | 79.7% | 5.0x |
| Arizona | 9,676 | 78.6% | 9.6x |
| California | 8,258 | 85.8% | 2.5x |
| Tennessee | 7,808 | 80.9% | 4.2x |
| Oklahoma | 6,097 | 90.2% | 9.4x |
| Arkansas | 6,017 | 83.7% | 15.8x |
| New Mexico | 3,570 | 90.6% | 5.6x |
| Mississippi | 3,522 | 84.1% | 4.7x |
Top payers in Pathology and Lab
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| BCBSTX | 62,662 | 82.3% | 5.5x |
| Cigna / MultiPlan | 17,404 | 74.5% | 3.7x |
| UnitedHealthcare | 15,219 | 79.4% | 4.2x |
| Aetna | 13,994 | 84.4% | 2.3x |
| UMR | 8,373 | 81.9% | 3.8x |
| Cigna (cigna.com) | 7,975 | 80.9% | 4.8x |
| Anthem Blue Cross | 6,676 | 86.4% | 3.6x |
| BLUE CROSS AND BLUE SHIELD OF ARIZONA | 5,722 | 79% | 13.2x |
Open the Pathology and Lab dashboard
Filter the live explorer by state, payer, and year to compare Pathology and Lab outcomes against your own claim mix.
FAQ
How many Pathology and Lab federal IDR disputes are in the dataset?
This benchmark shows 164,354 Pathology and Lab disputes.
What is the Pathology and Lab provider win rate?
The non-default provider win rate is 81%.
What should Pathology and Lab 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.