{
  "dataset": "Median prevailing offer relative to QPA by specialty, second half of 2025",
  "period": {
    "start": "2025-07-01",
    "end": "2025-12-31",
    "label": "H2 2025"
  },
  "source": {
    "publisher": "U.S. Departments of Health and Human Services, Labor, and the Treasury",
    "document": "Supplemental Background on Federal Independent Dispute Resolution Public Use Files, July 1, 2025 – December 31, 2025, and the accompanying Federal IDR Supplemental Tables for 2025 Q3 and 2025 Q4",
    "sourceFormat": "XLSX",
    "sourceUpdated": "2026-07-22",
    "sourceUrl": "https://www.cms.gov/initiatives/no-surprise-billing/overview/policies-resources/independent-dispute-resolution-reports",
    "note": "Figures are transcribed from the published federal tables. Nothing here is estimated, modelled or adjusted. Where a value is a sum of the two quarters, the field name says so.",
    "table": "Table 14 — Prevailing Offers Relative to QPA by Specialty"
  },
  "fields": {
    "cpt_range": "CPT code range as published",
    "category": "Specialty category as named by CMS",
    "q3_2025_multiple": "Ratio of the median prevailing offer to the plan's qualifying payment amount. CMS reports this column as a percentage in the 2025 workbooks (522) and as a ratio in the 2024 workbooks (5.53); the value here is always a ratio.",
    "q4_2025_multiple": "Ratio of the median prevailing offer to the plan's qualifying payment amount. CMS reports this column as a percentage in the 2025 workbooks (522) and as a ratio in the 2024 workbooks (5.53); the value here is always a ratio.",
    "determinations_h2_2025": "Payment determinations, sum of the two quarters",
    "items_or_services_h2_2025": "Items or services covered by those determinations, sum of the two quarters. Dividing this by determinations gives the average number of items per determination, which is one way to see batching intensity."
  },
  "rows": [
    {
      "cpt_range": "99281 - 99288",
      "category": "Emergency Department Services",
      "q3_2025_multiple": 3.24,
      "q4_2025_multiple": 3.34,
      "determinations_h2_2025": 590265,
      "items_or_services_h2_2025": 894625
    },
    {
      "cpt_range": "70010 - 79999",
      "category": "Radiology",
      "q3_2025_multiple": 4.73,
      "q4_2025_multiple": 3.98,
      "determinations_h2_2025": 170853,
      "items_or_services_h2_2025": 417963
    },
    {
      "cpt_range": "00100 - 01999",
      "category": "Anesthesia",
      "q3_2025_multiple": 3.26,
      "q4_2025_multiple": 3.61,
      "determinations_h2_2025": 116912,
      "items_or_services_h2_2025": 164331
    },
    {
      "cpt_range": "10004 - 69990",
      "category": "Surgery",
      "q3_2025_multiple": 14.49,
      "q4_2025_multiple": 15.03,
      "determinations_h2_2025": 109221,
      "items_or_services_h2_2025": 128450
    },
    {
      "cpt_range": "0001U - 0475U, 80047 - 89398",
      "category": "Pathology and Laboratory",
      "q3_2025_multiple": 4.52,
      "q4_2025_multiple": 4.4,
      "determinations_h2_2025": 69871,
      "items_or_services_h2_2025": 322092
    },
    {
      "cpt_range": "95700 - 96020",
      "category": "Neurology and Neuromuscular Procedures",
      "q3_2025_multiple": 23.94,
      "q4_2025_multiple": 25.85,
      "determinations_h2_2025": 66541,
      "items_or_services_h2_2025": 96255
    },
    {
      "cpt_range": "96360 - 96549",
      "category": "Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions and Chemotherapy and Other Highly Complex Biologic Agent Administration",
      "q3_2025_multiple": 4.28,
      "q4_2025_multiple": 4.24,
      "determinations_h2_2025": 44392,
      "items_or_services_h2_2025": 96342
    },
    {
      "cpt_range": "92920 - 93799",
      "category": "Cardiovascular",
      "q3_2025_multiple": 4.74,
      "q4_2025_multiple": 4.74,
      "determinations_h2_2025": 27878,
      "items_or_services_h2_2025": 34661
    },
    {
      "cpt_range": "99217 - 99239",
      "category": "Hospital Inpatient and Observation Care Services",
      "q3_2025_multiple": 3.58,
      "q4_2025_multiple": 3.7,
      "determinations_h2_2025": 26735,
      "items_or_services_h2_2025": 58380
    },
    {
      "cpt_range": "99291 - 99292",
      "category": "Critical Care Services",
      "q3_2025_multiple": 3.21,
      "q4_2025_multiple": 3.47,
      "determinations_h2_2025": 24514,
      "items_or_services_h2_2025": 35690
    },
    {
      "cpt_range": "N/A",
      "category": "Air Ambulance",
      "q3_2025_multiple": 2.53,
      "q4_2025_multiple": 2.37,
      "determinations_h2_2025": 20416,
      "items_or_services_h2_2025": 26598
    },
    {
      "cpt_range": "93880 - 93998",
      "category": "Noninvasive Vascular Diagnostic Studies",
      "q3_2025_multiple": 6.87,
      "q4_2025_multiple": 6.71,
      "determinations_h2_2025": 10159,
      "items_or_services_h2_2025": 12250
    },
    {
      "cpt_range": "94002 - 94799",
      "category": "Pulmonary",
      "q3_2025_multiple": 4.22,
      "q4_2025_multiple": 4.16,
      "determinations_h2_2025": 6889,
      "items_or_services_h2_2025": 7089
    },
    {
      "cpt_range": "90476 - 91322",
      "category": "Vaccines, Toxoids",
      "q3_2025_multiple": 3.21,
      "q4_2025_multiple": 3.33,
      "determinations_h2_2025": 2058,
      "items_or_services_h2_2025": 2146
    },
    {
      "cpt_range": "90460 - 90474",
      "category": "Immunization Administration for Vaccines/Toxoids",
      "q3_2025_multiple": 3.72,
      "q4_2025_multiple": 3.73,
      "determinations_h2_2025": 1992,
      "items_or_services_h2_2025": 2001
    },
    {
      "cpt_range": "99424 - 99491",
      "category": "Care Management Services",
      "q3_2025_multiple": 2.28,
      "q4_2025_multiple": 2.39,
      "determinations_h2_2025": 1345,
      "items_or_services_h2_2025": 4594
    },
    {
      "cpt_range": "99202 - 99215",
      "category": "Office or Other Outpatient Services",
      "q3_2025_multiple": 10.79,
      "q4_2025_multiple": 3.75,
      "determinations_h2_2025": 1299,
      "items_or_services_h2_2025": 1635
    },
    {
      "cpt_range": "99466 - 99480",
      "category": "Inpatient Neonatal Intensive Care Services and Pediatric/Neonatal Critical Care Services",
      "q3_2025_multiple": 2.26,
      "q4_2025_multiple": 2.38,
      "determinations_h2_2025": 1210,
      "items_or_services_h2_2025": 4364
    },
    {
      "cpt_range": "99100 - 99140",
      "category": "Qualifying Circumstances for Anesthesia",
      "q3_2025_multiple": 4.96,
      "q4_2025_multiple": 5.74,
      "determinations_h2_2025": 896,
      "items_or_services_h2_2025": 928
    },
    {
      "cpt_range": "99000 - 99091",
      "category": "Special Services, Procedures and Reports",
      "q3_2025_multiple": 6.31,
      "q4_2025_multiple": 5.56,
      "determinations_h2_2025": 823,
      "items_or_services_h2_2025": 840
    },
    {
      "cpt_range": "99421 - 99474",
      "category": "Non-Face-to-Face Services",
      "q3_2025_multiple": 2.17,
      "q4_2025_multiple": 2.26,
      "determinations_h2_2025": 816,
      "items_or_services_h2_2025": 2004
    },
    {
      "cpt_range": "99151 - 99157",
      "category": "Moderate (Conscious) Sedation",
      "q3_2025_multiple": 6.73,
      "q4_2025_multiple": 6.66,
      "determinations_h2_2025": 563,
      "items_or_services_h2_2025": 760
    },
    {
      "cpt_range": "99497 - 99498",
      "category": "Advance Care Planning",
      "q3_2025_multiple": 7.5,
      "q4_2025_multiple": 5.93,
      "determinations_h2_2025": 372,
      "items_or_services_h2_2025": 398
    },
    {
      "cpt_range": "97010 - 97799",
      "category": "Physical Medicine and Rehabilitation",
      "q3_2025_multiple": 3.91,
      "q4_2025_multiple": 4.02,
      "determinations_h2_2025": 363,
      "items_or_services_h2_2025": 532
    },
    {
      "cpt_range": "92502 - 92700",
      "category": "Special Otorhinolaryngologic Services",
      "q3_2025_multiple": 3.77,
      "q4_2025_multiple": 4.12,
      "determinations_h2_2025": 258,
      "items_or_services_h2_2025": 329
    },
    {
      "cpt_range": "99170 - 99199",
      "category": "Other Services and Procedures",
      "q3_2025_multiple": 4.08,
      "q4_2025_multiple": 4.14,
      "determinations_h2_2025": 209,
      "items_or_services_h2_2025": 386
    },
    {
      "cpt_range": "99354 - 99418",
      "category": "Prolonged Services",
      "q3_2025_multiple": 2.67,
      "q4_2025_multiple": 5.34,
      "determinations_h2_2025": 191,
      "items_or_services_h2_2025": 285
    },
    {
      "cpt_range": "99242 - 99255",
      "category": "Consultations",
      "q3_2025_multiple": 7,
      "q4_2025_multiple": 6.8,
      "determinations_h2_2025": 174,
      "items_or_services_h2_2025": 185
    },
    {
      "cpt_range": "99381 - 99429",
      "category": "Preventive Medicine Services",
      "q3_2025_multiple": 2.25,
      "q4_2025_multiple": 3.11,
      "determinations_h2_2025": 151,
      "items_or_services_h2_2025": 240
    },
    {
      "cpt_range": "95004 - 95199",
      "category": "Allergy and Clinical Immunology",
      "q3_2025_multiple": 3.32,
      "q4_2025_multiple": 2.5,
      "determinations_h2_2025": 101,
      "items_or_services_h2_2025": 101
    },
    {
      "cpt_range": "99460 - 99463",
      "category": "Newborn Care Services",
      "q3_2025_multiple": 2.41,
      "q4_2025_multiple": 2.76,
      "determinations_h2_2025": 96,
      "items_or_services_h2_2025": 184
    },
    {
      "cpt_range": "90785 - 90899",
      "category": "Psychiatry",
      "q3_2025_multiple": 1.46,
      "q4_2025_multiple": 2.15,
      "determinations_h2_2025": 43,
      "items_or_services_h2_2025": 115
    },
    {
      "cpt_range": "99464 - 99465",
      "category": "Delivery/Birthing Room",
      "q3_2025_multiple": 2.58,
      "q4_2025_multiple": 2.88,
      "determinations_h2_2025": 37,
      "items_or_services_h2_2025": 42
    },
    {
      "cpt_range": "91010 - 91322",
      "category": "Gastroenterology",
      "q3_2025_multiple": 67.8,
      "q4_2025_multiple": 25.64,
      "determinations_h2_2025": 29,
      "items_or_services_h2_2025": 31
    },
    {
      "cpt_range": "90281 - 90399",
      "category": "Immune Globulins, Serum or Recombinant Products",
      "q3_2025_multiple": null,
      "q4_2025_multiple": 3.94,
      "determinations_h2_2025": 25,
      "items_or_services_h2_2025": 26
    },
    {
      "cpt_range": "99304 - 99316, 99341 - 99350, 99483 - 99486, 99499 - 99499",
      "category": "Other Eval & Management",
      "q3_2025_multiple": null,
      "q4_2025_multiple": 15.09,
      "determinations_h2_2025": 16,
      "items_or_services_h2_2025": 48
    },
    {
      "cpt_range": "90935 - 90999",
      "category": "Dialysis",
      "q3_2025_multiple": null,
      "q4_2025_multiple": 2.05,
      "determinations_h2_2025": 14,
      "items_or_services_h2_2025": 14
    },
    {
      "cpt_range": "92002 - 92499",
      "category": "Ophthalmology",
      "q3_2025_multiple": null,
      "q4_2025_multiple": 2,
      "determinations_h2_2025": 11,
      "items_or_services_h2_2025": 11
    }
  ]
}