How the No Surprises Act applies
IONM and neurodiagnostic claims can produce high QPA multiples in federal IDR. The workflow depends on the setting, whether patient protections apply, and whether the claim belongs in federal IDR or a state process.
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 |
|---|---|---|---|---|---|
| 95938 | Short-latency somatosensory evoked potential study, stimulation of any/all... | 55,067 | 84.6% | 49.3x | $2,800 |
| 95941 | Continuous intraoperative neurophysiology monitoring, from outside the operating... | 36,657 | 85.3% | 14.3x | $5,325 |
| 95939 | Central motor evoked potential study (transcranial motor stimulation); in upper and... | 30,795 | 83.9% | 21.3x | $2,860 |
| 95861 | Needle electromyography; 2 extremities with or without related paraspinal areas | 21,758 | 85.2% | 26.2x | $3,000 |
| 95955 | Electroencephalogram (EEG) during nonintracranial surgery (eg, carotid surgery) | 17,514 | 86.6% | 48.3x | $5,100 |
| 95937 | Neuromuscular junction testing with repetitive nerve stimulation | 16,493 | 86.7% | 76.7x | $6,225 |
| G0453 | Continuous intraoperative neurophysiology monitoring (IONM), from outside the... | 13,145 | 78% | 17.5x | $3,588 |
| 95870 | Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial)... | 12,816 | 83% | 123.8x | $4,800 |
Top payers
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| BCBSTX | 43,852 | 93.9% | 59.4x |
| UnitedHealthcare | 28,371 | 77% | 27.3x |
| Anthem Blue Cross | 22,487 | 82.6% | 67.8x |
| Cigna / MultiPlan | 13,082 | 77.6% | 34.9x |
| Aetna | 9,982 | 88.8% | 22.5x |
| Florida Blue | 9,469 | 92.7% | 16.9x |
| UMR | 8,708 | 81.2% | 21.5x |
| Cigna | 2,761 | 77.7% | 6.6x |
Top states
| State | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Texas | 39,734 | 89.3% | 70.4x |
| Florida | 14,701 | 86.1% | 20.2x |
| Ohio | 12,337 | 79.1% | 92.2x |
| New Jersey | 12,040 | 82.9% | 39.5x |
| Pennsylvania | 6,807 | 84.1% | 17.9x |
| New York | 6,362 | 82.7% | 39.9x |
| Arizona | 6,263 | 82.4% | 45.4x |
| Colorado | 6,087 | 81.4% | 27.1x |
Operational checklist
- Confirm the surgical or facility context and whether notice-and-consent rules are relevant.
- Separate technical, professional, and monitoring-code issues before filing.
- Benchmark codes such as 95938, 95941, 95939, and G0453 separately.
- Build evidence around complexity, monitoring time, staffing, and comparable outcomes.
Benchmark your Neurodiagnostics & IONM 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 neurodiagnostics & ionm?
Sometimes. Eligibility depends on the service setting, plan type, patient protections, state-law routing, and whether deadlines were preserved.
How many Neurodiagnostics & IONM federal IDR disputes are in the dataset?
IDR Explorer shows 165,409 Neurodiagnostics & IONM federal IDR disputes in the current benchmark set.
What should neurodiagnostics & ionm 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.