How the No Surprises Act applies
Radiology disputes often come from facility-based or emergency imaging where the patient had little control over the interpreting provider. The operational question is whether the claim is protected and whether federal IDR or state law controls payment resolution.
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 |
|---|---|---|---|---|---|
| 74177 | CT scan of the abdomen and pelvis with IV contrast | 62,338 | 87.6% | 6.5x | $1,070 |
| 71046 | Chest X-ray, 2 views | 46,246 | 86% | 7.6x | $130 |
| 70450 | CT scan of the head/brain without contrast | 46,065 | 89.2% | 5.3x | $388 |
| 71045 | Chest X-ray, single view | 43,227 | 89.7% | 6.2x | $99 |
| 74176 | CT scan of the abdomen and pelvis without contrast | 34,644 | 86.9% | 6.6x | $1,022 |
| 77067 | Screening mammography, bilateral | 27,070 | 95.2% | 3.1x | $192 |
| 77063 | Screening digital breast tomosynthesis (3D mammogram), bilateral | 26,620 | 95.1% | 2.6x | $130 |
| Q9967 | Low osmolar radiology contrast material, per mL | 22,838 | 81.5% | 5.7x | $352 |
Top payers
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| UnitedHealthcare | 121,297 | 89.1% | 6.5x |
| Aetna | 101,746 | 96.9% | 4.4x |
| BCBSTX | 66,636 | 82.7% | 6.8x |
| Cigna / MultiPlan | 49,603 | 86% | 7.7x |
| UMR | 25,568 | 92% | 4.5x |
| Cigna | 16,339 | 86.5% | 2.9x |
| Anthem Blue Cross | 6,208 | 88.4% | 4.5x |
| Blue Cross and Blue Shield of Arizona | 5,832 | 78.9% | 12.6x |
Top states
Operational checklist
- Separate emergency imaging from non-emergency facility-based imaging.
- Check whether the facility and plan context creates a protected NSA claim.
- Benchmark CT, X-ray, ultrasound, and contrast codes on their own economics.
- Watch payer and state mix; radiology outcomes vary sharply by market.
Benchmark your Radiology & Imaging 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 radiology & imaging?
Sometimes. Eligibility depends on the service setting, plan type, patient protections, state-law routing, and whether deadlines were preserved.
How many Radiology & Imaging federal IDR disputes are in the dataset?
IDR Explorer shows 424,336 Radiology & Imaging federal IDR disputes in the current benchmark set.
What should radiology & imaging 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.