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No Surprises Act · Federal IDR
That payment is an opening offer.
Federal IDR, by code, state, payer, and specialty.
Out of network surgical claims are routinely paid below the billed charge or denied outright. Most practices treat what arrives as the amount owed. Under the No Surprises Act it is not — it is an opening offer, and federal Independent Dispute Resolution exists specifically to contest it.
IDR is a process problem, not a legal mystery. The rules and the deadlines are fixed and published, which is exactly what makes the work automatable and why so few practices do it by hand.
Why these claims get paid short — and how the gap gets recovered
There is a defined federal pathway between a payer's underpayment and a binding arbitrated amount: an open negotiation window, an eligibility determination, a batching decision, then arbitration. Each step has a hard deadline, and missing one forfeits the claim. That is precisely the work Sydra automates — screening eligibility, assembling the evidence and offer, filing, and tracking every deadline so nothing lapses by default.
~88%
of IDR determinations are won by providers who actually contest them.
You keep it
A flat, predictable fee — less than half of what most contingency firms charge. We file it, you keep the recovery.
New to this? Read the plain-English guides, see what one denied claim is worth, or .
Browse denials by specialty
Find your procedure and see why it gets paid short out of network, and how federal IDR recovers the gap.
Spine surgery
52 disputed codes →
Cervical and lumbar fusion, decompression, instrumentation, and neurostimulation codes that surgical billing teams dispute most often under the No Surprises Act.
Orthopedic surgery
56 disputed codes →
Joint replacement, arthroscopy, and fracture repair codes with high out-of-network exposure for orthopedic groups.
Neurosurgery
27 disputed codes →
Cranial, vascular, functional, and peripheral nerve procedure codes where federal IDR awards routinely exceed the insurer qualifying payment amount.
Plastic and reconstructive surgery
26 disputed codes →
Reconstructive flap, graft, breast, and soft tissue codes frequently underpaid on an out-of-network basis.
Interventional pain
26 disputed codes →
Epidural injections, facet procedures, radiofrequency ablation, and sacroiliac codes that interventional pain practices take through dispute resolution.
Hand surgery
3 disputed codes →
Carpal tunnel, tendon, and small joint codes that hand surgeons take through independent dispute resolution.
Emergency medicine
9 disputed codes →
Emergency department visit levels, critical care, and emergency procedures — the archetypal No Surprises Act claims, since patients cannot choose an in-network emergency provider.
Radiology
10 disputed codes →
CT, MRI, and ultrasound interpretations read by hospital-based radiologists who are frequently out of network even at an in-network facility, and protected under the No Surprises Act.
Pathology
9 disputed codes →
Surgical pathology, immunohistochemistry, and cytology reads billed by hospital-based pathologists the patient never chose — protected out-of-network claims routinely paid short.
Anesthesia
10 disputed codes →
Anesthesia for surgery, endoscopy, and labor billed by an anesthesiologist or CRNA who is frequently out of network even when the surgeon and facility are in network — a core No Surprises Act protected claim, billed on base plus time units and routinely underpaid.
Podiatry
4 disputed codes →
Foot and ankle surgical and procedural codes billed by podiatrists — bunion and hammertoe correction, fracture repair, and reconstruction — frequently underpaid on an out-of-network basis and protected under the No Surprises Act.
Neonatology
3 disputed codes →
NICU and newborn critical-care services billed by neonatologists who are frequently out of network at an in-network hospital — protected No Surprises Act claims that are routinely paid short.
Assistant Surgeons
4 disputed codes →
Surgical assistant services (modifiers 80, 81, and 82) billed alongside an in-network primary surgeon — often out of network and denied or underpaid on protected No Surprises Act claims.
Ophthalmologic Surgeons
4 disputed codes →
Cataract, retinal, corneal, and other eye-surgery codes with high out-of-network exposure — protected surprise-billing claims frequently paid below the fair rate.
Hospitalists
3 disputed codes →
Inpatient physician services billed by hospitalists a patient never chose, frequently out of network at an in-network facility — a core No Surprises Act protected claim.
Intensivists
3 disputed codes →
Critical-care services billed by intensivists in the ICU — hospital-based, often out of network even at an in-network facility, and protected under the No Surprises Act.
Physician Assistants
4 disputed codes →
Services billed by physician assistants supporting surgical and hospital-based care — frequently out of network and underpaid on protected No Surprises Act claims.
State IDR — browse by state
Federal IDR covers most out-of-network disputes, but 21 states have their own surprise-billing law for out-of-network payment on state-regulated (fully insured) plans — most run a state IDR or arbitration, and a few set payment by a state formula. Self-funded ERISA plans still route to federal IDR, so the plan type decides which process applies.
States with their own out-of-network process
Every state — see your pathway
Browse by payer
See how each major payer underpays out-of-network claims — and how federal IDR contests it.
Federal IDR — common questions
What is IDR for a CPT code?
Independent dispute resolution is the federal process for contesting an underpayment on a specific procedure. Either party can initiate it once the required open negotiation period has passed without resolution.
How is the qualifying payment amount calculated for a code?
The qualifying payment amount is generally the payer's median in network rate for the same or similar service in the same geographic area, adjusted annually. It is the plan's anchor, not a cap. Sydra pulls the correct amount for each CPT rather than requiring a manual lookup.
What determines whether a claim wins in IDR?
Certified IDR entities weigh the offer against the qualifying payment amount, the complexity of the service, the provider's training and experience, and market share, among other factors defined in the federal rule. There is no guaranteed outcome. A documented offer with real comparables performs meaningfully better than a bare number.
Compare your options
How Sydra stacks up against the other ways to handle out-of-network recovery — honestly, including when each alternative is the right call.
Recover the out-of-network payments you're owed.
Bring one denied claim. We'll tell you whether federal IDR would contest the payment and what it's worth.
No outcome is guaranteed. Results vary by claim, payer, specialty, and documentation. Any general figures reflect the published federal record across all disputes, not a prediction about your claim. This is general information, not legal or financial advice.
Medically & clinically reviewed by Dr. John M. Abrahams, MD
Board-certified neurosurgeon and founder of Sydra · Last reviewed September 2026 · About the author
Sources
Figures reflect the published federal record across all disputes, not a prediction about any individual claim. This is general information, not legal or financial advice.