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What Federal Arbitration Awarded, Specialty by Specialty

The Departments publish the median prevailing offer as a percentage of the qualifying payment amount, broken out by CPT category. It is the closest thing that exists to an official answer to “how far below market is my plan paying me?” — and it varies enormously by specialty.

All Categories

Median Prevailing Offer as a Share of QPA

Median prevailing offer relative to the qualifying payment amount, by specialty category, Q3 and Q4 2025
CategoryCPT rangeQ4 2025Q3 2025Determinations, H2 2025
Emergency Department Services99281 - 992883.34×3.24×590,265
Radiology70010 - 799993.98×4.73×170,853
Anesthesia00100 - 019993.61×3.26×116,912
Surgery10004 - 6999015.03×14.49×109,221
Pathology and Laboratory0001U - 0475U, 80047 - 893984.4×4.52×69,871
Neurology and Neuromuscular Procedures95700 - 9602025.85×23.94×66,541
Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions and Chemotherapy and Other Highly Complex Biologic Agent Administration96360 - 965494.24×4.28×44,392
Cardiovascular92920 - 937994.74×4.74×27,878
Hospital Inpatient and Observation Care Services99217 - 992393.7×3.58×26,735
Critical Care Services99291 - 992923.47×3.21×24,514
Air AmbulanceN/A2.37×2.53×20,416
Noninvasive Vascular Diagnostic Studies93880 - 939986.71×6.87×10,159
Pulmonary94002 - 947994.16×4.22×6,889
Vaccines, Toxoids90476 - 913223.33×3.21×2,058
Immunization Administration for Vaccines/Toxoids90460 - 904743.73×3.72×1,992
Care Management Services99424 - 994912.39×2.28×1,345
Office or Other Outpatient Services99202 - 992153.75×10.79×1,299
Inpatient Neonatal Intensive Care Services and Pediatric/Neonatal Critical Care Services99466 - 994802.38×2.26×1,210
Qualifying Circumstances for Anesthesia99100 - 991405.74×4.96×896
Special Services, Procedures and Reports99000 - 990915.56×6.31×823
Non-Face-to-Face Services99421 - 994742.26×2.17×816
Moderate (Conscious) Sedation99151 - 991576.66×6.73×563

Categories with fewer than 500 payment determinations across the half-year are omitted, because a median computed on a handful of decisions says nothing useful. Source: CMS Federal IDR Supplemental Tables, Q3 and Q4 2025, Table 14. Across all categories in that period, certified IDR entities issued 1,145,039 payment determinations and the provider side prevailed in 85.4% of them.

A high multiple is not a promise. It reflects how far the plan's benchmark sat from what an independent entity found defensible, in disputes that reached a decision — roughly one in five initiated disputes was found ineligible and never got that far. What it does tell you is where the measured gap is widest.
In Depth

Specialty Briefings

Emergency Medicine
3.34×
median prevailing offer vs QPA · 590,265 determinations, H2 2025
Radiology
3.98×
median prevailing offer vs QPA · 170,853 determinations, H2 2025
Anesthesiology
3.61×
median prevailing offer vs QPA · 116,912 determinations, H2 2025
Neurology & Neurodiagnostics
25.85×
median prevailing offer vs QPA · 66,541 determinations, H2 2025
Surgery
15.03×
median prevailing offer vs QPA · 109,221 determinations, H2 2025
Pathology & Laboratory
4.4×
median prevailing offer vs QPA · 69,871 determinations, H2 2025
Critical Care
3.47×
median prevailing offer vs QPA · 24,514 determinations, H2 2025
Vascular Diagnostics
6.71×
median prevailing offer vs QPA · 10,159 determinations, H2 2025
Cardiovascular
4.74×
median prevailing offer vs QPA · 27,878 determinations, H2 2025
Hospital Medicine
3.7×
median prevailing offer vs QPA · 26,735 determinations, H2 2025
Infusion & Injection Therapy
4.24×
median prevailing offer vs QPA · 44,392 determinations, H2 2025
Pulmonary
4.16×
median prevailing offer vs QPA · 6,889 determinations, H2 2025
Neonatal & Pediatric Critical Care
2.38×
median prevailing offer vs QPA · 1,210 determinations, H2 2025
Care Management
2.39×
median prevailing offer vs QPA · 1,345 determinations, H2 2025
Telehealth & Remote Services
2.26×
median prevailing offer vs QPA · 816 determinations, H2 2025
Air Ambulance
2.37×
median prevailing offer vs QPA · 20,416 determinations, H2 2025