How the No Surprises Act applies
Anesthesia claims often turn on facility setting, patient consent rules, and whether state or federal law controls payment resolution. For provider teams, the operational work is routing the claim, preserving deadlines, and benchmarking the payer and code mix before filing IDR.
Do not treat every out-of-network claim as an IDR claim. Start with patient protections and routing, then decide whether the public IDR benchmarks support escalation.
High-volume service codes
| Code | Service | Disputes | Provider win rate | Median award | Median award dollars |
|---|---|---|---|---|---|
| 00812 | Anesthesia for screening colonoscopy | 28,711 | 83% | 9.4x | $1,620 |
| 00731 | Anesthesia for upper GI endoscopic procedures | 14,893 | 83% | 6.5x | $1,604 |
| 00813 | Anesthesia for combined upper and lower GI endoscopy | 10,861 | 82.7% | 6.9x | $1,981 |
| 00811 | Anesthesia for lower intestinal endoscopy (e.g., colonoscopy) | 10,555 | 80.3% | 6.7x | $1,512 |
| 00840 | Anesthesia for lower-abdomen intraperitoneal procedures (e.g., laparoscopy) | 10,200 | 83.8% | 3.5x | $2,145 |
| 01967 | Neuraxial labor anesthesia (epidural for planned vaginal delivery) | 7,837 | 81.3% | 2.9x | $4,193 |
| 01400 | Anesthesia for open or arthroscopic knee joint procedures | 7,497 | 82.1% | 6.5x | $2,212 |
| 00790 | Anesthesia for upper-abdomen intraperitoneal procedures | 7,118 | 84.5% | 3.5x | $2,389 |
Top payers
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| UnitedHealthcare | 56,157 | 81.1% | 4.5x |
| Cigna / MultiPlan | 40,365 | 80.5% | 3.2x |
| Aetna | 28,143 | 88.6% | 8x |
| Cigna | 26,237 | 83.3% | 2.8x |
| Blue Cross and Blue Shield of Arizona | 16,135 | 79.8% | 34.3x |
| UMR | 15,644 | 82.8% | 4.5x |
| Anthem Blue Cross | 14,089 | 85.9% | 3.2x |
| BCBSTX | 12,521 | 95% | 8.8x |
Top states
Operational checklist
- Confirm whether the anesthesia service is tied to a protected facility or emergency encounter.
- Check notice-and-consent facts before assuming federal IDR applies.
- Separate endoscopy, obstetric, orthopedic, and pain-related anesthesia codes.
- Benchmark QPA multiples by payer, state, and code before setting a final offer.
Benchmark your Anesthesiology claims
IDR Explorer compares your claim mix against CMS Federal IDR outcomes by payer, state, specialty, and service code.
FAQ
Does the No Surprises Act apply to anesthesiology?
Sometimes. Eligibility depends on the service setting, plan type, patient protections, state-law routing, and whether deadlines were preserved.
How many Anesthesiology federal IDR disputes are in the dataset?
IDR Explorer shows 242,469 Anesthesiology federal IDR disputes in the current benchmark set.
What should anesthesiology teams benchmark first?
Start with payer, state, and service-code mix, then compare QPA multiple, win rate, default rate, and timing against similar disputes.
Related guides
Sources and method
- CMS: Federal IDR reports and public use files
- CMS: About Independent Dispute Resolution
- CMS: Federal IDR timeline for claims
This guide uses CMS Federal IDR public use files through 2025Q4 and is for general information only. Confirm eligibility, deadlines, and state-law routing with current federal guidance, the relevant regulator, and counsel.