Neurology and Neurodiagnostic Services: 25.85× the Insurer's Own Benchmark
In the last quarter of 2025 the median prevailing offer in neurology and neurodiagnostic services disputes was 25.85× the qualifying payment amount — the figure the plan itself calculated. Across the second half of 2025, certified IDR entities decided 66,541 payment determinations in this category, covering 96,255 items or services.
What the Federal Data Says About Neurology and Neurodiagnostic Services
How to read this. The qualifying payment amount is the plan's own calculated benchmark — generally the median contracted rate for the service in the geographic area. A median prevailing offer of 25.85× QPA means that in half of the decided disputes in this category, the offer the certified IDR entity selected was at least 25.85 times what the plan had calculated. It is a measure of the gap between the plan's benchmark and what an independent entity found defensible. It is not a prediction, a guarantee, or an average recovery for any particular practice, and it does not include disputes that were found ineligible or that closed before a determination. CPT range for this category: 95700–96020 (neurodiagnostic testing, including intraoperative neurophysiological monitoring).
Source: CMS, Federal Independent Dispute Resolution Process — Supplemental Tables, Q3 and Q4 2025, Table 14 (prevailing offers relative to QPA by specialty) and Table 12 (payment determination outcomes). Published by CMS here.
Why Neurology and Neurodiagnostic Services Claims End Up Out of Network
This category carries the highest median multiple in the entire federal dataset — higher than surgery, radiology or emergency medicine — and the reason is worth understanding before you file.
The CPT range covers neurodiagnostic testing, and in practice the disputed volume is dominated by intraoperative neuromonitoring. IONM is performed during a surgery the patient consented to, by a physician or technologist the patient never selected, frequently supervised remotely from another state. It is the archetype of a service delivered out of network with no meaningful choice on the patient's side.
Plans have historically priced these services at a level far below what the market bears, and when a certified IDR entity compares the two offers against the statutory factors, the gap that emerges is unusually wide. A high median multiple does not mean a high probability of any particular outcome — but it does mean that groups in this category who never file are leaving the largest measured gap on the table.
Deciding Whether a Claim Is Worth Disputing
Three things determine whether a specific claim belongs in federal arbitration, and none of them is the specialty itself.
1. Is the claim eligible?
Roughly one in five disputes initiated in 2025 was found ineligible — the single largest source of wasted effort in this process. Eligibility turns on whether the item or service falls under the federal protections rather than a state process, whether open negotiation ran its full 30 business days, and whether the dispute was filed within the four-business-day window that follows. Getting this wrong costs the fee and the claim.
2. Does the arithmetic work?
Since June 11, 2026, the administrative fee is $15 per party per dispute, down from $115. The certified IDR entity fee is set within a range published annually by the Departments and is paid by the non-prevailing party. Against those costs, the relevant question is the gap between the plan's payment and a defensible value for the service — and the federal data shows that gap by claim size is largest on smaller claims, not larger ones.
3. Can the claims be batched?
Qualifying claims may be submitted together in a single dispute. For a neurology and neurodiagnostic services practice generating similar claims against the same plan, batching is usually what turns a marginal economic case into a clear one.
We review claims against these three tests before anything is filed, and we are paid only out of what is actually recovered. If the claims do not clear the tests, we say so.